Pain improvement and reoperation rate after full-endoscopic decompression for lateral recess stenosis: a 10-year follow-up.

PURPOSE: To share long-term clinical outcomes and our experience with full-endoscopic interlaminar decompression (FEI) for lateral recess stenosis (LRS). METHODS: We included all patients who underwent FEI for LRS from 2009 to 2013. VAS for leg pain, ODI, neurological findings, radiographic findings, and complications were analyzed at one week, one month, three months, and one year postoperation. The telephone interview for local patients with simple questions was done approximately ten years after the operation. International patients receive an email with the same questionnaire as local patients during the same follow-up period. RESULTS: One hundred and twenty-nine patients underwent FEI for LRS with complete data during 2009-2013. Most of the patients (70.54%) had LRS radiculopathy for less than one year, mainly L4-5 (89.92%), followed by L5-S1 (17.83%). Early outcomes three months after surgery showed that most patients (93.02%) reported significant pain relief, and 70.54% reported no pain at their ODI scores were significantly reduced from 34.35 to 20.32% (p = 0.0052). In contrast, the mean VAS for leg pain decreased substantially by 3.77 points (p < 0.0001). There were no severe complications. At ten years of follow-up, 62 patients responded to the phone call or email. 69.35% of the patients reported having little or no back or leg pain, did not receive any further lumbar surgery, and were still satisfied with the result of the surgery. There were six patients (8.06%) who underwent reoperation. CONCLUSION: FEI for LRS was satisfactory at 93.02%, with a low complication rate during the early follow-up period. Its effect seems to decline slightly in the long term at a 10-year follow-up. 8.06% of the patients subsequently underwent reoperation.

Bilateral Lumbar Facet Synovial Cysts as a Cause of Radiculopathy.

Remarkable advancements in endoscopic spinal surgery have led to successful outcomes comparable to those of conventional open surgery with the benefits of less traumatization and postoperative spinal instability. Bilateral lumbar facet cysts are rarely found in the spinal canal. We report a rare case of L4-L5 bilateral lumbar facet cysts compressing the nerve root in a patient who presented with L5 radiculopathy. Endoscopic decompression and removal of the cysts without fusion were performed. Histopathology revealed synovial cysts. Postoperatively, the patient showed a total resolution of symptoms with sustained benefits at the final evaluation. No recurrence of pain and no further segmental instability were observed at the 1-year follow-up.

Full-Endoscopic Interlaminar Lumbar Discectomy: Retrospective Review of Clinical Results and Complications in 545 International Patients.

BACKGROUND: Minimally invasive techniques have been developed to provide access to the disc with better visualization while causing less muscle trauma and its consequences. This study was aimed at evaluating the clinical outcomes and complications of the fully endoscopic lumbar discectomy interlaminar approach in a large number of patients. METHODS: Patients diagnosed with lumbar herniated nucleus pulposus who underwent fully endoscopic interlaminar lumbar discectomy between 2011 and 2016 were reviewed. Perioperative data, preoperative and postoperative Oswestry Disability Index (ODI) scores, visual analog scale (VAS) back pain scores, VAS leg pain scores, and complications were evaluated and recorded at 1 week and 3 and 6 months postoperatively and each year thereafter. RESULTS: The study cohort comprised 545 patients (average age, 46.43 years; 34.31% female). The affected levels were L2-3 in 1.47%, L3-4 in 6.96%, L4-5 in 49.45%, and L5-S1 in 44.69%. Mean preoperative ODI, VAS back pain score, and VAS leg pain score were 43.00%, 5.00, and 5.69, respectively. Postoperative ODI at 1 month was reduced to 15.59% and remained within a range of 14.83%18.32% throughout follow-up. Postoperative VAS back and leg pain score results at 1 week were decreased to 1.66 and 1.79, respectively, and remained at 1.89-3.14 and 1.59-2.66, respectively, throughout follow-up. Sixty-six recurrences (12.11%) were diagnosed. Intraoperative complications were nerve root-related (n = 3) and dural tear (n = 1). Postoperative complications included numbness (n = 18), weakness (n = 5), and residual disc (n = 1). No infections or hematomas were reported. CONCLUSIONS: Fully endoscopic interlaminar lumbar discectomy is a safe, effective option for treating lumbar disc herniation, with a long recurrence-free recovery.

GhABF2, a bZIP transcription factor, confers drought and salinity tolerance in cotton (Gossypium hirsutum L.).

The bZIP transcription factor (TF) act as an important regulator for the abscisic acid (ABA) mediated abiotic stresses signaling pathways in plants. Here, we reported the cloning and characterization of GhABF2, encoding for typical cotton bZIP TF. Overexpression of GhABF2 significantly improved drought and salt stress tolerance both in Arabidopsis and cotton. However, silencing of GhABF2 made transgenic cotton sensitive to PEG osmotic and salt stress. Expression of GhABF2 was induced by drought and ABA treatments but repressed by high salinity. Transcriptome analysis indicated that GhABF2 increases drought and salt tolerance by regulating genes related to ABA, drought and salt response. The proline contents, activity of superoxide dismutase (SOD) and catalase (CAT) were also significantly increased in GhABF2-overexpression cottons in comparison to wild type after drought and salt treatment. Further, an increase in fiber yield under drought and saline-alkali wetland exhibited the important role of GhABF2 in enhancing the drought and salt tolerance in transgenic lines. In conclusion, manipulation of GhABF2 by biotechnological tools could be a sustainable strategy to deploy drought and salt tolerance in cotton.