Limited discectomy versus aggressive discectomy by spinal endoscopy with the transforaminal approach for lumbar disc herniation: a retrospective study.

OBJECTIVE: To compare the clinical and radiological outcomes of limited discectomy (LD) and aggressive discectomy (AD) performed via spinal endoscopy using the transforaminal approach in patients with lumbar disc herniation(LDH) METHODS: We conducted a retrospective review of patients who underwent percutaneous endoscopic transforaminal discectomy (PETD) at the L4-L5 lumbar spine segments in our department from January 2017 to December 2020. The follow-up period extended to 24 months postoperatively. Patients were categorized into the LD and AD groups based on the extent of intraoperative disc removal. We retrospectively collected and analyzed clinical and radiological data. RESULTS: The study followed 65 patients, with 36 in the LD group and 29 in the AD group. No statistically significant differences were noted in recurrence rates, the excellent and good Macnab rates, preoperative Disc Height Index (DHI), and preoperative Modic changes between the groups (P >0.05). However, significant differences were observed in operation duration, postoperative DHI and postoperative Modic change (P<0.05). No significant differences in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were detected between the groups preoperatively, or one and two years postoperatively (P>0.05). Nevertheless, notable differences in VAS and ODI scores were present one month postoperatively (P<0.05). CONCLUSION: As a conventional surgical method for treating LDH, PETD can achieve satisfactory clinical results in both LD and AD, with no significant variance in recurrence rates. However, AD is associated with longer operation times, and greater postoperative reductions in DHI and greater postoperative Modic changes compared to LD.

Comparison of clinical outcomes and complications between endoscopic and minimally invasive transforaminal lumbar interbody fusion for lumbar degenerative diseases: a systematic review and meta-analysis.

OBJECTIVE: This study compares the efficacy and complications of endoscopic transforaminal lumbar fusion (Endo-TLIF) and minimally invasive transforaminal lumbar fusion (MIS-TLIF) in treating lumbar degenerative diseases. It aims to provide reference data for clinical decision-making. METHODS: We identified randomized controlled studies and non-randomized controlled studies on Endo-TLIF and MIS-TLIF for treating lumbar degenerative diseases based on specific inclusion and exclusion criteria. Data were managed with Endnote X9 software and meta-analyzed using Revman 5.3 software. Extracted outcomes included lower back VAS score, lower extremity pain VAS score, low back pain ODI score, complication rate, fusion rate, time to surgery, blood loss, and length of hospital stay. RESULTS: ① Thirteen high-quality studies were included in this meta-analysis, totaling 1015 patients-493 in the Endo-TLIF group and 522 in the MIS-TLIF group. ② Meta-analysis results revealed no significant differences in preoperative, postoperative 6-month, and final follow-up waist VAS scores, lower limb pain VAS score, ODI index, complications, and fusion rate between the two groups (P > 0.05). The MIS-TLIF group had a shorter operative time (MD = 29.13, 95% CI 10.86, 47.39, P = 0.002) than the Endo-TLIF group. However, the Endo-TLIF group had less blood loss (MD = - 76.75, 95% CI - 111.59, - 41.90, P < 0.0001), a shorter hospital stay (MD = - 2.15, 95% CI - 2.95, - 1.34, P < 0.00001), and lower lumbar VAS scores both immediately postoperative (≤ 2 week) (MD = - 1.12, 95% CI - 1.53, - 0.71, P < 0.00001) compared to the MIS-TLIF group. CONCLUSION: Meta-analysis results indicated that Endo-TLIF is similar to MIS-TLIF in terms of long-term clinical outcomes, fusion rates, and complication rates. Although MIS-TLIF has a shorter operation time, Endo-TLIF can significantly reduce blood loss and hospital stay duration. Endo-TLIF offers the advantages of less surgical trauma, reduced blood loss, faster recovery, and early alleviation of postoperative back pain.

Effect of different cement distribution in bilateral and unilateral Percutaneous vertebro plasty on the clinical efficacy of vertebral compression fractures.

BACKGROUND: The ramifications of osteoporotic fractures and their subsequent complications are becoming progressively detrimental for the elderly population. This study evaluates the clinical ramifications of postoperative bone cement distribution in patients with osteoporotic vertebral compression fractures (OVCF) who underwent both bilateral and unilateral Percutaneous Vertebroplasty (PVP). OBJECTIVE: The research aims to discern the influence of bone cement distribution on the clinical outcomes of both bilateral and unilateral Percutaneous Vertebroplasty. The overarching intention is to foster efficacious preventive and therapeutic strategies to mitigate postoperative vertebral fractures and thereby enhance surgical outcomes. METHODS: A comprehensive evaluation was undertaken on 139 patients who received either bilateral or unilateral PVP in our institution between January 2018 and March 2022. These patients were systematically classified into three distinct groups: unilateral PVP (n = 87), bilateral PVP with a connected modality (n = 29), and bilateral PVP with a disconnected modality (n = 23). Several operational metrics were juxtaposed across these cohorts, encapsulating operative duration, aggregate hospital expenses, bone cement administration metrics, VAS (Visual Analogue Scale) scores, ODI (Oswestry Disability Index) scores relative to lumbar discomfort, postoperative vertebral height restitution rates, and the status of the traumatized and adjacent vertebral bodies. Preliminary findings indicated that the VAS scores for the January and December cohorts were considerably reduced compared to the unilateral PVP group (P = 0.015, 0.032). Furthermore, the recurrence of fractures in the affected and adjacent vertebral structures was more pronounced in the unilateral PVP cohort compared to the bilateral PVP cohorts. The duration of the procedure (P = 0.000) and the overall hospitalization expenses for the unilateral PVP group were markedly lesser than for both the connected and disconnected bilateral PVP groups, a difference that was statistically significant (P = 0.015, P = 0.024, respectively). Nevertheless, other parameters, such as the volume of cement infused, incidence of cement spillage, ODI scores for lumbar discomfort, post-surgical vertebral height restitution rate, localized vertebral kyphosis, and the alignment of cement and endplate, did not exhibit significant statistical deviations (P > 0.05). CONCLUSION: In juxtaposition with unilateral PVP, the employment of bilateral PVP exhibits enhanced long-term prognostic outcomes for patients afflicted with vertebral compression fractures. Notably, bilateral PVP significantly curtails the prevalence of subsequent vertebral injuries. Conversely, the unilateral PVP cohort is distinguished by its abbreviated operational duration, minimal invasiveness, and reduced overall hospitalization expenditures, conferring it with substantial clinical applicability and merit.

Efficacy and Safety Study of Low-Molecular-Weight Heparin and Fondaparinux Sodium After Hip Arthroplasty: A Retrospective Cohort Study.

Background: Low molecular heparin(LMWH) and sodium sulfadiazine heparin(FPX) are commonly used to prevent deep vein thrombosis(DVT) after total hip arthroplasty(THA). In this study, we compared the role of these drugs in preventing DVT after THA. Methods: Patients who underwent unilateral THA at the Sixth Affiliated Hospital of Xinjiang Medical University from April 2020 to December 2022 were retrospectively analyzed for inclusion in this study. According to the anticoagulant drugs used, the patients were divided into LMWH group (n=106) and FPX group (n=97). Changes in perioperative coagulation-related indices, hemoglobin, blood loss And the postoperative complications. Results: The preoperative indexes of the two groups of patients, the difference was not statistically significant (P>0.05); the indexes of Intraoperative blood loss, Visible blood loss, Hidden blood loss, and Total blood loss of the two groups of patients were compared, and the difference was not significant (P>0.05); PT activity and INR in the LMWH group were significantly lower than those in the FPX group on the 1st and 5th postoperative days, and the differences were significant (P<0.05); Platelets, Hemoglobin, Hematocrit, D-dimer, and Fibrinogen were compared between the two groups on the 1st and 5th postoperative days, and the differences were not significant (P<0.05). The differences were not significant (P>0.05). The differences in blood transfusion rate and blood volume between the two groups were not significant (P>0.05); the total hospitalization cost of the LMWH group was significantly lower than that of the FPX group, and the difference was significant (P<0.05); and the differences in the incidence of postoperative complications between the two groups were not significant (P>0.05). Conclusion: In this study, we found that the efficacy and safety of FPX and LMWH in preventing VTE after THA were basically the same, and the total cost of hospitalization in the LMWH group was significantly lower than that in the FPX group; however, due to the limited inclusion of the sample size, high-quality, large-sample, long-term follow-up clinical studies are necessary.

Anatomical research on strength of screw track fixation in novel cortical bone trajectory for osteoporosis lumbar spine.

OBJECTIVES: The cortical bone screw has good internal fixation effect on osteoporotic bone. In order to further increase the strength of screw track fixation in cortical bone trajectory, this study introduced a modified technique with novel insertion point and angle for cortical bone screw placement. METHODS: Cortical bone screws were placed in four dry and six wet and intact lumbar specimens according to the modified technique. A total of 100 trajectories in specimens were confirmed by X-ray and CT scan to evaluate the safety, accuracy and practicability of screw fixation. The successful rate was 95% (38/40) in four dry specimens, and 88.7% (53/60) in six wet specimens. CONCLUSION: This study showed that the novel trajectory could be fixed more closely with cortical bone compared to traditional cortical bone trajectory technique, and thus it may reduce the surgical exposure to the elders and help them to recover quickly after the operation.

Measurement of lumbar isthmus parameters for novel starting points for cortical bone trajectory screws using computed radiography.

The current study aims to measure distance parameters in lumbar isthmus to develop new references for lumbar pedicle screw insertion. Using computed radiography, the distance between the median pedicle tangent and the isthmus lateral tangent (D1) and the isometric distance between the isthmus lateral tangent and the inferior border of transverse process (D2) were measured on 120 spine X-ray images. A derived distance D3 (equal to D2 minus 1 mm) was calculated. These parameters were used to define the starting points for pedicle screws. Cortical bone trajectory (CBT) fixations were carried out on six wet (including 3 male and 3 female) and 4 dry lumbar specimens using the new system, and were evaluated for accuracy and safety of screw insertion. Measurements showed that D1 (mm) was 2.1±0.13 (L1), 2.3±0.13 (L2), 3.6±0.33 (L3), 4.4±0.36 (L4), 5.7±0.36 (L1); D2 was 5±0.83 (L1), 6.19±0.84 (L2), 5.38±0.86 (L3), 3.66±0.42 (L4) and 2.30±0.37 (L5). A total of 100 CBTs were evaluated. Among them, 7 out of the 60 screws in the 6 wet specimens penetrated into the lateral pedicle bone, the successful rate was 88.7%; 2 out of the 40 screws in the 4 dry specimens penetrated through the lateral or median pedicle bone, the successful rate was of 95%. With our new system, CBT screws can be placed based on these parameters, which can be obtained less invasively, and irrespective of articular degeneration in lumbar facet and morphological variation in the transverse process. Our data show that the technique is safer, less invasive, and easier to operate. It would help reduce bleeding, intraoperative X-ray exposure and surgical time.

Debridement and Internal Fixation from a Single Posterior Approach for the Treatment of Lumbosacral Tuberculosis.

OBJECTIVE: To evaluate the application and therapeutic effects of debridement from a single posterior approach for bone grafting and internal fixation treatment of lumbosacral tuberculosis. METHODS: From January 2010 to December 2016, 96 patients with lumbosacral tuberculosis were treated by single posterior debridement and internal fixation with bone graft. Among these patients, there were 9 cases involving the L3-L4 segment, 57 involving L4-L5, and 30 involving L5-S1. Interlaminar debridement was applied in 60 cases and transforaminal debridement was applied in 36 cases. Evaluation of therapeutic effects included the Prolo scale and visual analogue scale. The kyphotic angle and height loss of the vertebral body in the affected region of the lumbosacral segment were measured radiologically. RESULTS: All patients were followed up for 12-24 months. In the interlaminar group, the mean preoperative, postoperative, and final kyphotic angles were -24.1 ± 5.5°, -34.6 ± 5.6°, and -32.1 ± 5.1°, respectively. In contrast, those in the transforaminal group were -25.1 ± 5.9°, -35.0 ± 6.6°, and -33.3 ± 5.9°, respectively. There was significant improvement of the postoperative angle compared with the preoperative angle. The result of the modified Prolo scale was 93.8%. According to the visual analogue scale, the preoperative and postoperative scales were 7.8 and 2.7, indicating a significant alleviation of pain. CONCLUSIONS: Debridement from single posterior approach is an effective technique for the internal fixation of lumbosacral regional spinal tuberculosis. An appropriate selection of indications, careful evaluation of radiology, and thorough debridement were the key to a successful operation.

Micro-endoscopic discectomy versus percutaneous endoscopic surgery for lumbar disk herniation.

Objective This study was performed to compare the effectiveness and safety of percutaneous endoscopic lumbar discectomy (PELD) versus micro-endoscopic discectomy (MED) in the treatment of patients with lumbar disk herniation. Methods In total, 216 patients treated for lumbar disk herniation in our center from January 2016 to July 2017 were prospectively divided into two groups according to the treatment received. One group was treated with PELD and the other group was treated with MED. The surgical duration, intraoperative blood loss, total hospital stay, visual analog scale (VAS) pain score, and Oswestry disability index (ODI) score before and after the surgery were compared between the groups. Results The surgical duration was significantly longer in the PELD than MED group. The intraoperative blood loss volume was significantly larger in the MED than PELD group. The total hospital stay was significantly longer in the MED than PELD group. The decline in the VAS pain score and increase in the ODI score after surgery were not significantly different between the two groups. Conclusions Although PELD is associated with a longer surgical duration than MED, it should still be considered superior to MED because of less intraoperative hemorrhage and a significantly shorter hospitalization time.