[Meta-analysis of calcium chemotherapeutic effect of anterior cervical subtotal vertebroplasty and posterior laminoplasty].

OBJECTIVE: To systematically assess the efficacy of anterior cervical corpectomy and fusion (ACCF) versus posterior laminoplasty (LAMP) for cervical ossification of posterior longitudinal ligament (OPLL). METHODS: PubMed and EMBASE, Cochrane Library, CBM, CNKI, Wanfang and VIP were collected from 7 databases of ACCF, LAMP from 1970 to May 2018. According to the criteria, the articles were included and independently screened by two authors. The quality of the articles was assessed by using the MINORS scale (methodological index for non randomized studies). After extracting the data from the article, the JOA score, cervical curvature, operation time, bleeding volume, excellent and good rate, recovery rate, adverse events and secondary surgery were analyzed by using Review Manager 5.3 software. RESULTS: Finally, a total of 22 articles with 1 678 patients were included in this Meta-analysis, with 810 patients in ACCF group and 868 patients in LAMP group. Meta analysis results showed that the ACCF group had higher postoperative JOA scores[MD=0.63, 95%CI(0.05, 1.20), P= 0.03], higher excellent rate [OR=1.85, 95%CI (1.14, 3.02), P=0.01] and higher recovery rate [OR=11.90, 95%CI (5.75, 18.05), P=0.000 1]. But the LAMP group has a shorter operative time [MD=52.19, 95%CI (29.36, 75.03), P<0.000 01], less complications [OR=1.56, 95%CI (1.03, 2.35), P=0.04] and less reoperations [OR=3.73, 95%CI (1.62, 8.57), P=0.002]. There was no significant different in postoperative lordosis [MD=3.15, 95%CI(-0.14, 6.43), P=0.06] and blood loss[SMD= 0.26, 95%CI(-0.05, 0.57), P=0.10] between two groups. CONCLUSION: The recovery of functionof ACCF group was better, but operation time, complications and reoperations of LAMP group were all better than ACCF group. There was no difference in postoperative lordosis and intraoperative blood loss between two groups. However, there are some limitations in this study. Therefore, higher quality and larger sample size clinical studies are needed to further verify.

[Auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery].

OBJECTIVE: To observe the auxiliary analgesic effect of wrist-ankle acupuncture on patients undergoing transforaminal endoscope surgery. METHODS: A total of 64 patients with lumbar disc herniation who underwent percutaneous lateral transforaminal endoscope surgery were randomly divided into an observation group and a control group, 32 cases in each group. The patients in the control group were treated with injection of 1% lidocaine for routine local infiltration anesthesia. The patients in the observation group were treated with wrist-ankle acupuncture at lower 5 area and lower 6 area for 30 min, 5 min before routine local infiltration anesthesia; immediately, 15 min, 30 min after insertion the left-right technique, up-down technique, and rotation technique were applied for six times, respectively. The mean arterial pressure (MAP), heart rate (HR), blood oxygen saturation (SpO2) and pain visual analogue scale (VAS) were compared between the two groups at the time points of intraoperative puncture (T1), circular saw grinding (T2), and placement of working channel (T3). The intention of reoperation was recorded immediately after operation and 24 h after operation. The expectation and treatment credibility scale (ETCS) was used to evaluate the relationship between patients' expectation and efficacy 5 min before operation and immediately after operation. RESULTS: At T2 and T3 during the operation, the MAP and HR in the obserrvation group were lower than those in the control group, while SpO2 was higher than that in the control group (P<0.05). At T1, there was no significant difference of MAP, HR and SpO2 between the two groups (P>0.05). At T2, the peak VAS and average VAS in the observation group were lower than those in the control group (P<0.05), but there was no significant difference at T1 and T3 (P>0.05). The intention of reoperation in the observation group was higher than that in the control group both immediately after operation and 24 h after operation (P<0.05). In the observation group, the scores of each item in ETCS immediately after operation were higher than those 5 min before operation (P<0.05), while in the control group there was no significant difference between immediately after operation and 5 min before operation (P>0.05). The scores of ETCS1, ETCS2 and ETCS3 immediately after operation in the observation group were higher than those in the control group (P<0.05). CONCLUSION: The wrist-ankle acupuncture has positive auxiliary analgesic effect on lumbago during transforaminal endoscope surgery, and strengthens the patients' confidence on the operation effect.

Percutaneous Full-Endoscopic Lumbar Foraminoplasty and Decompression by Using a Visualization Reamer for Lumbar Lateral Recess and Foraminal Stenosis in Elderly Patients.

BACKGROUND: Percutaneous endoscopic lumbar discectomy has been widely used to treat lumbar disc herniation; its advantages are less trauma, faster recovery, lower costs, and higher percentage of patient satisfaction compared with open surgery. Treatment of lumbar spinal stenosis with percutaneous full-endoscopic surgery is still challenging, especially for elderly patients with multiple comorbidities and complex pathologic factors. The aim of this study was to introduce percutaneous full-endoscopic lumbar foraminoplasty and decompression using a visualization reamer in elderly patients with lateral recess and foraminal stenosis and evaluate efficacy and safety. METHODS: This retrospective review comprised 65 consecutive elderly patients (30 men and 35 women) with lateral recess and foraminal stenosis who underwent percutaneous full-endoscopic lumbar foraminoplasty and discectomy from January 2017 to September 2017. Visual analog scale and Oswestry Disability Index were used to evaluate pain relief and neurologic improvement. RESULTS: Mean patient age was 71.58 years (range, 65-89 years). Mean follow-up period was 16.12 months (range, 12-20 months). Mean operative time was 98.59 minutes per level (range, 55-120 minutes). Mean intraoperative perspective frequency was 3.21 times (range, 2-6 times). Mean hospital stay after the procedure was 2.18 days (range, 1-4 days). Back and leg visual analog scale and Oswestry Disability Index scores at all time points in the postoperative period were significantly lower than preoperatively (P < 0.01). At final follow-up, modified MacNab criteria were rated as follows: excellent, 47 patients (72.31%); good, 12 patients (16.92%); fair, 3 patients (4.62%); and poor, 4 patients (6.15%). Therefore, excellent or good results were obtained in 89.23% of patients. CONCLUSIONS: Percutaneous full-endoscopic lumbar foraminoplasty and discectomy using a visualization reamer is an effective and safe treatment for elderly patients with lumbar lateral recess and foraminal stenosis. It improves safety and efficiency of decompression and reduces intraoperative fluoroscopy.