Comparative efficacy of traditional conservative treatment and CT-guided local chemotherapy for mild spinal tuberculosis.

BACKGROUND: There are considerable differences in the treatment strategy for spinal tuberculosis, including conservative or surgical procedures. Conservative treatment is always suitable for most patients. This study aimed to compare the clinical efficacy of traditional conservative treatment with CT-guided local chemotherapy strategy of mild spinal tuberculosis. METHODS: This research retrospectively analysed 120 patients with spinal tuberculosis between January 2005 and January 2016 according to the diagnostic criteria of mild spinal tuberculosis. In total, 89 patients underwent traditional conservative treatment, 31 underwent CT-guided local chemotherapy. Clinical outcome, laboratory indexes, and radiological results were analysed to provide a clinical basis for the choice of mild spinal tuberculosis treatment. RESULTS: All cases achieved a clinical cure with 24 to 50 months followed up. Cobb angle of the two groups spinal tuberculosis segments was 6.25 ± 3.1100B0, 5.69 ± 2.5800B0 before treatment and 12.36 ± 6.3100B0, 14.87 ± 7.2600B0 after treatment, respectively. The VAS scores were significantly decreased post-treatment. At the 1 month follow-up, the VAS scores and erythrocyte sedimentation rate (ESR) were significantly differences between the two groups. The efficacy in the CT-guided local chemotherapy (Group B) was better than the traditional conservative treatment (Group A). But from the 3 months follow-up to the last follow-up, the VAS scores and ESR was no significant differences between the two groups and the average ESR decreased to normal. There was no evident kyphosis, symptoms or neurological deficits at the final follow-up. The paravertebral abscesses had disappeared, with no significant progression of local kyphosis, significant absorption and clear lesion edges, pain relief and normal ESR in the two groups. CONCLUSIONS: For mild spinal tuberculosis, traditional conservative treatment can achieve satisfactory results. The strategy combined with CT-guided local chemotherapy treatment is minimally invasive, beneficial for the drainage of paravertebral abscesses and pain relief.

Lumbar degenerative disease treated by percutaneous endoscopic transforaminal lumbar interbody fusion or minimally invasive surgery-transforaminal lumbar interbody fusion: a case-matched comparative study.

PURPOSE: This study aimed to evaluate the clinical efficacy and imaging results of percutaneous endoscopic transforaminal lumbar interbody fusion (PETLIF) through comparing it with minimally invasive surgery-transforaminal lumbar interbody fusion (MISTLIF). MATERIALS AND METHODS: We performed a retrospective analysis on patients with lumbar degenerative disease treated by PETLIF or MISTLIF from September 2017 to January 2019, and the patients were divided into two groups: the PETLIF group and the MISTLIF group. The clinical and imaging parameters of the two groups were evaluated. RESULTS: There was no significant difference between the two groups in operative time and complication rate. The estimated blood loss and the length of hospital stay in the PETLIF group were significantly better than those in the MISTLIF group. Compared with those before operation, the postoperative VAS-L and VAS-B scores were significantly improved after operation in the both groups. In addition, the postoperative VAS-B score of the PETLIF group was significantly lower than that of the MISTLIF group. At the last follow-up, there was no significant difference between the two groups in the VAS-L score, VAS-B score, ODI score, and bony fusion rate. CONCLUSIONS: Both PETLIF and MISTLIF could achieve satisfactory clinical outcomes in the treatment of lumbar degenerative disease, but our study suggested that PETLIF had less damage, rapid recovery after operation, and short discharge time.

Subarachnoid hemorrhage after full endoscopic transforaminal lumbar interbody fusion: a case report.

PURPOSE: Intracranial hemorrhage such as subarachnoid hemorrhage (SAH) is a rare but severe complication of spinal surgery. Current case reports of open lumbar surgery are typically accompanied by intraoperative dural tears and cerebrospinal fluid (CSF) leakage. We report a case of non-aneurysmal SAH without CSF leakage after full endoscopic transforaminal lumbar interbody fusion (FE-TLIF). DESIGN: Case report and literature review. RESULTS: A 62-year-old male patient underwent FE-TLIF for L4/5 lumbar spinal stenosis. There was no intraoperative dural tear or postoperative CSF leakage. The patient reported neck pain immediately after the surgery. Around 12 h after the surgery, the patient complained of mild headaches. One day after the surgery, the patient reported severe headaches, accompanied by nausea and vomiting. CT showed a high-density shadow in part of the sulcus and cistern, suggesting SAH. No apparent neurological symptoms were present. The patient's condition improved after conservative treatment including bed rest, fluid infusions, and blood pressure control. Twelve days after the surgery, CT and MRA of the brain showed no hemorrhage and the patient was discharged. CONCLUSION: This case was among the first that developed SAH without CSF leakage after FE-TLIF. Although the underlying pathologic mechanism is unknown, epidural hypertension may be a possible cause of the hemorrhage. Timely CT or magnetic resonance imaging (MRI) examinations may help to detect this complication and initiate early treatment.

Analysis of clinical efficacy of endo-LIF in the treatment of single-segment lumbar degenerative diseases.

An innovative concept was proposed to treat the lumbar degenerative diseases with full-endoscopic translaminar lumbar interbody fusion (Endo-TLIF) and the efficacy was evaluated. A total of 44 patients from January 2017 to October 2018 were enrolled, including 20 patients undergoing full-endoscopic TLIF and 24 patients undergoing standard open TLIF. The Visual Analogue Scale (VAS) score, Oswestry Dability Index (ODI) and intervertebral fusion were observed in both groups at the last follow-up. The height and width of intervertebral foramen and height of intervertebral space were evaluated via imaging. Mean follow-up time for all patients 13.2 ±â€¯3.2 months. The average operation time was 184.3 ±â€¯70.6 min in experimental group and 191.1 ±â€¯32.4 min in control group. The amount of bleeding was 38.5 ±â€¯19.5 mL and 214.6 ±â€¯61.6 mL. The VAS score was 4.9 ±â€¯1.0 points in experimental group and 4.8 ±â€¯1.0 points in control group before operation, and 0.8 ±â€¯0.6 points and 0.8 ±â€¯0.7 points at the last follow-up. The ODI was 83.5 ±â€¯7.8% and 87.8 ±â€¯5.9% before operation, and 9.9 ±â€¯3.6% and 9.3 ±â€¯3.7% at the last follow-up. The height and width of intervertebral foramen and height of intervertebral space in both groups were significantly improved (p < 0.05). The fusion rate at the last follow-up were 95% (19 cases) in experimental group and 92% (22 cases) in control group. Full-endoscopic TLIF is feasible in the treatment of single-segment lumbar degenerative diseases, which is characterized by small trauma, quick recovery and low cost. However, the large-sample long-term follow-up is needed to further evaluate its clinical efficacy and safety.

Using Visual Trepan to Treat Single Segment Ossification of the Ligamentum Flavum Under Endoscopy.

This article describes the trepan technique for treating single segment ossification of the ligamentum flavum (OLF) using an endoscope. OLF is the most common cause of thoracic spinal stenosis. The most common surgical procedures involve semi-lamina or full-lamina resection and decompression. However, considering the anatomical structure of the thoracic spinal canal and the combination of OLF, traditional surgery has higher risks, more complications, and greater technical requirements. In the past ten years, with the development of endoscopic technology, spinal endoscopy has been increasingly applied for the treatment of intervertebral disc herniation and spinal canal stenosis. The present study demonstrated the effectiveness of visual trepan decompression under spinal endoscopy used for patients with single segment OLF. This surgical procedure had many advantages, including a shorter operation time, minimal trauma, less expenditure, and better functional recovery over the conventional open surgery.

The Effect of Using Visual Trepan to Treat Single-Segment Ossification of Ligamentum Flavum Under the Endoscope.

OBJECTIVES: To evaluate the surgical outcome of using a trepan to treat single-segment ossification of ligamentum flavum under endoscopy and the clinical value of the new surgical treatment. MATERIALS AND METHODS: Patients who underwent surgery for single-segment ossification of ligamentum flavum from January 2015 to June 2018 were included in a retrospective analysis. Endoscopic visual trepan decompression was performed in 26 patients and posterior spinal canal resection and decompression was performed in 11 patients. Japanese Orthopaedic Association scores, Japanese Orthopaedic Association improvement rate, and visual analog scale scores of both groups were recorded during follow-up. Computed tomography was used to evaluate patients' residual area ratio of the vertebral canal. Operative time, length of stay, amount of bleeding, and hospital cost in both groups were recorded. RESULTS: Average follow-up time was 8.9 ± 2.7 months. Average operative time was 100.6 ± 35.0 minutes in the experimental group and 140.5 ± 28.3 minutes in the control group. At the final follow-up, the average improvement rate of Japanese Orthopaedic Association score was 78.3% in the experimental group and 84.2% in the control group. The average residual area ratio of the vertebral canal, which was <50% before the operation in both groups, recovered to 100% in both groups after the operation. Visual analog scale score of all patients was significantly (P < 0.05) reduced at the final follow-up. CONCLUSIONS: The visual trepan technique using a spinal endoscope can be used to treat single-segment ossification of ligamentum flavum. Advantages include less trauma, faster recovery, and lower cost. However, more cases and long-term follow-up are required to further evaluate the clinical effectiveness and safety of this surgical method.