Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after...Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.展开更多
Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has bee...Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.展开更多
Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20...Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.展开更多
Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthe...Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.Methods Consecutively treated patients with lumbar pathology who underwent MIDLF(n=16)and a historical control group who underwent MI-TLIF(n=34)were included.Clinical symptoms were evaluated using Oswestry Disability Index(ODI),the 36-Item Short-Form Health Survey,and visual analog scale(VAS)scores before surgery and 3,6,12,and 24 months after surgery.Results The mean operative time and hematocrit(HCT,Day 1)were significantly shorter and lower in MIDLF cases(174 min vs.229 min,P<0.001;0.34 vs.0.36,P=0.037).The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively.VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months.At 24 months follow-up,VAS back pain was higher in MI-TLIF than in MIDLF cases(P=0.018).Conclusion MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates,and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.展开更多
Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on...Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.展开更多
Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar...Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar single segment lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy surgery in our hospital. The operation time, incision size, bleeding volume and hospitalization time were recorded respectively. The patients were evaluated before operation, 1 month and 6 months after operation. Visual analogue scale (VAS) and assessment were used to evaluate the lumbocrural pain. The JOA score and the Oswestry disability index (ODI) were used to evaluate the lumbar function, and the modified macnab score was used to evaluate the clinical effect in the last follow-up. Results: All the 42 patients successfully completed the operation without any other operation. There were no severe complications such as dural injury and nerve root injury. The operation time was (76.98 ± 8.58) min, the incision size was (8.45 ± 1.2) mm, the bleeding volume was (20.14 ± 2.93) ml, and the hospitalization time was (4.55 ± 1.13) d. One month and six months after the operation, the visual analogue scale (VAS), the evaluation of lumbar function (Oswestry) and the disability index (ODI) were significantly improved compared with those before the operation (P Conclusion: The treatment of low lumbar but segmental lumbar disc herniation with percutaneous intervertebral foramen, with small incision, less bleeding and quick recovery, can improve the pain and dysfunction of patients.展开更多
Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar interver...Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.展开更多
Objective:To analyze the efficacy of lateral transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:A total of 44 patients with lumbar disc herniation,treated in Yancheng No.l People'...Objective:To analyze the efficacy of lateral transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:A total of 44 patients with lumbar disc herniation,treated in Yancheng No.l People's Hospital from January 2019 to June 2020,were randomly divided into two groups;the 24 patients in group A were treated by lateral transforaminal endoscopic surgery,while the 20 patients in group B were treated by routine lamina fenestration and nucleus pulposus surgery.Results:The curative effect of group A(91.67%)was higher than that of group B(85.0%),P>0.05;there was no significant difference in the angle from straight leg raise between group A and group B(P>0.05);the Oswestry Disability Index(ODI)and the visual analogue scale(VAS)of group A were lower than those of group B(P<0.05);the incision length,intraoperative blood loss,and hospital stay of the patients in group A were better than those in group B,P<0.05.Conclusion:Lateral transforaminal endoscopic surgery can significantly reduce pain,improve symptoms,and help to restore normal function in the early stage for patients with lumbar disc herniation.展开更多
BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spi...BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.展开更多
Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation w...Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation who underwent surgical treatment in our hospital between January 2013 and January 2017 were selected and randomly divided into two groups: Percutaneous transforaminal endoscope discectomy (PTED) group and control group. Patients in PTED group received percutaneous transforaminal endoscope discectomy, while control group received open fenestration discectomy. Serum levels of pain substances SP, NPY, PGE2 and NGF, inflammatory mediators IFN-γ, TNF-α, IL-17 and MMP3 as well as stress response substances Cor, NE, OH-, O2- and MDA of two groups of patients were determined the same day after surgery and 3 days after surgery.Results: The same day after surgery and 3 d after surgery, serum SP, NPY, PGE2, NGF, IFN-γ, TNF-α, IL-17, MMP3, Cor, NE, OH-, O2- and MDA levels of PTED group were significantly lower than those of control group. Conclusion: Percutaneous transforaminal endoscope discectomy for lumbar intervertebral disc herniation causes less postoperative pain and inflammatory stress than open fenestration discectomy.展开更多
Objective:To investigate the therapeutic effect of transforaminal endoscope in patients with spinal metastases.Methods:Clinical data of 28 patients with spinal metastases admitted to our hospital from May 2015 to May ...Objective:To investigate the therapeutic effect of transforaminal endoscope in patients with spinal metastases.Methods:Clinical data of 28 patients with spinal metastases admitted to our hospital from May 2015 to May 2019 were retrospectively collected.According to different surgical methods,they were divided into control group(20 cases)and experimental group(8 cases),among which control group was treated with traditional open palliative decompression,while the experimental group was treated with transforaminal endoscopic decompression.The surgery and recovery indicators were compared between the two groups,including surgery time,incision length,postoperative drainage volume,out of bed activity time,length of hospital stay,the Japanese Orthopaedic Association(JOA)scores of 7 days after surgery,pain degree,complications(wound infection,transient reduction of muscle strength,hypoproteinemia with wound drainage and delayed healing),and activity of daily living.Results:The surgery time,incision length,postoperative drainage volume,out of bed activity time,and postoperative length of hospital stay of the experimental group were all less than those of the control group,and the JOA score of 7 days after surgery was higher than that of the control group,showing statistically significant differences(P<0.05).VAS scores of the experimental group on the day 1 and day 7 after surgery were lower than those of the control group,with statistically significant differences(P<0.05).The incidence of complications in the experimental group was slightly lower than that in the control group,but the difference was not significant(P>0.05).Conclusions:Transforaminal endoscope used in suitable patients with spinal metastases can greatly reduce the incision length,soft tissue and bone tissue damages,and postoperative drainage,promote early mobilization and early discharge,and reduce a series of complications due to hemorrhage and hypoproteinemia,which has a better early clinical effect in comparison with the traditional open palliative decompression.展开更多
Objective:Transforaminal endoscope was used in the treatment of thoracic disc herniation and the therapeutic effect was discussed.Methods:Sixteen patients with thoracic disc herniation admitted to our hospital from Oc...Objective:Transforaminal endoscope was used in the treatment of thoracic disc herniation and the therapeutic effect was discussed.Methods:Sixteen patients with thoracic disc herniation admitted to our hospital from October 2018 to May 2019 were divided into control group and observation group according to the random number table method,with 8 patients in each group.The control group was treated with posterior laminectomy approach,and the observation group was treated with transforaminal endoscope.The surgery-related conditions(intraoperative blood loss,surgery time,and postoperative drainage volume),VAS score,JOA score and postoperative complications were compared and analyzed.Results:There was no statistically significant difference between the two groups in the total effective rate and preoperative VAS score(P>0.05).Compared with the control group,the observation group had shorter surgery time and incision length,less postoperative drainage volume,and higher VAS score 3 days after surgery,JOA score on day 7 after surgery,and JOA score 3 months after surgery,showing statistically significant differences(P<0.05).There was no significant difference in the complications between the two groups(X2=1.067,P=0.833).Conclusions:Transforaminal endoscope had a good clinical effect with small incision and injury in the treatment of patients with thoracic disc herniation.展开更多
To evaluate the clinical outcome,effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixati...To evaluate the clinical outcome,effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixation.A retrospective review of a consecutive series of 24 patients with traumatic lumbar spondylolisthesis treated with TLIF procedure was carried out.Intraoperative spinal cord monitoring was used to confirm the peripheral neural function intact during the reduction of the spondylolisthesis.Preoperative clinical and radiographic evaluation of all cases were originally collected prospectively.Data regarding blood loss,operative time,duration of hospital stay,radiographic fusion,instrumentation failure and clinical result were collected and observed at regular follow-up periods.All patients were engaged in high-energy accidents in the lower back and 16 patients had concomitant injuries.The mean operative time was 124 min,mean blood loss was 350 mL,and mean hospital stay was 6.5 days.There were no complications such as incision infection,cerebrospinal fluide (CSF) leakage and nerve root injury and so on.All patients demonstrated a solid lumbar interbody fusion within 4 months,and no evidence of spondylolisthesis correction loss,instrumentation failure and loosing.They all were completely asymptomatic,with normal neurologic findings,and had resumed their previous level of physical activities on the final follow-up.Meticulous clinical examination and careful imaging assessment could assist an early diagonosis in cases of traumatic lumbar spondylolisthesis.Performing open reduction and the TLIF procedure as soon as possible could restore segmental stability and painless function.The TLIF procedure was a safe,effective technique to treat traumatic lumbar spondylolisthesis.展开更多
As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to anal...As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)method.The intact FE models of L4-L5 were established and validated based on the CT images.On this basis,the FE models of MIS-TLIF and PETLIF were established and analyzed.It is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar stability.In addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.展开更多
Objective:To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases(LDD)who underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF)and to discuss the ...Objective:To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases(LDD)who underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF)and to discuss the potential strategy for the control of these complications.Methods:A total of 87 patients with LDD were treated with the MIS-TLIF procedure.Complications,including malposition or breakage of guide pin,percutaneous pedicle screw(PPS)or cages,neurological deficit,and superior-level facet joint violations,were determined during and after the surgery.Computed tomography(CT)was used to evaluate the PPS accuracy and the superior-level facet joint violations.Results:A total of 386 PPSs were used.During the surgery,3(0.8%)guide pin and 1(0.3%)PPS perforated the anterior wall of the vertebral body,respectively.One(0.3%)PPS was pulled out during the reduction of slip.Malposition of the cages occurred in 6(1.6%)PPSs.These were all adjusted accordingly during the surgery.All the patients received>2 years of follow-up.No loosening or breakage of PPS and cage was observed,but CT showed 27(7.0%)PPSs misplaced.No neurological deficit related to misplaced PPS was observed.The total facet joint violation(FJV)rate was 36.2%,with grade 2 and grade 3 violations is 21(12.1%)and 6(3.4%),respectively.Conclusion:MIS-TLIF has similar instrumentation-related complications with open TLIF.Accurate preoperative evaluation and improved surgical techniques can effectively reduce these instrumentation-related complications.展开更多
Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforamina...Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforaminal epidural injection of a mixture of long-acting anaesthetic(bupivacaine)and particulate steroids(depomedrol)has been a treatment modality in patients not responding to initial physiotherapy and neuropathic pain medications.Methods:To analyze the effectiveness of transforaminal epidural steroid injection(TFESI)in the treatment of low back pain with radiculopathy,a retrospective case series evaluating the records of patients that received TFESI(1 mL 0.5%bupivacaine+1 ml/40 mg depomedrol)under C-arm guidance from January 2015 to December 2018(3 years)at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences(UDM-NINAS),their lumbosacral MRI and the pre-procedure,1-week and 3-month numeric pain rating scale,were analyzed.Successful treatment(reduction of pain scale by more than 50%of baseline at 3 months)in the patients with bony recess stenosis and those with prolapsed intervertebral disc was compared.Results:Out of 67 patients that received TFESI,35(52.23%)could be followed up.The mean age was 55.8±14.39 years and 51.3%were females.68.57%had L5 and 20%had S1 radiculopathy.Bony recess stenosis was seen in the aged 40%and PIVD was the cause of radiculopathy in 60%.The median duration of radicular pain prior to intervention was 3 months.TFESI was effective as the mean numeric pain scale before injection was 8.97±1.32 which reduced to 3.91±3.23(paired t test p value<0.001)at 1 week post injection and 3.23±3.34(paired t test p value<0.001)at 3 months post injection.Twenty-six of the 35 patients(75.29%)had more than 50%pain relief compared to baseline at 3 months and were satisfied.Nine patients continued to have pain;however,only one required a surgical intervention.The effectiveness of TFESI was not significantly different in different ages(Fisher’s exact test p value 0.182)and in different anatomic levels(Fisher’s exact test p value 0.241).Six out of eight patients with bony recess stenosis benefited as compared to 14 out of 19 patients with PIVD,though it was not statistically significant(Fischer’s exact test p value 0.688).There were no adverse events recorded.Conclusion:TFESI is a safe and efficacious treatment modality in patients with radicular low back pain especially in aged patients in whom surgery under general anaesthesia is not free from risk.展开更多
Objective:We through the anatomy of cadavers to study the"Kambin’s triangle"in the safe working area of lumbar intervertebral foramen and to provide anatomical reference for clinical lumbar fusion through K...Objective:We through the anatomy of cadavers to study the"Kambin’s triangle"in the safe working area of lumbar intervertebral foramen and to provide anatomical reference for clinical lumbar fusion through Kambin’s triangle approach.Methods:five complete cadaveric specimens were taken,the soft tissue of the lumbar back was removed,the transverse process,upper and lower articular processes and part of the vertebral lamina were bitten,the Kambin’s triangle area of the lumbar spine was completely exposed,the bottom edge and height of the Kambin’s triangle were measured,and the area of the Kambin’s triangle was calculated;Using Kirschner wire,pull and fix the traveling nerve root to make the Kambin’s triangle into a rectangle,measure the length of the bottom edge and height again,calculate the area,and compare the two groups of data.Results:the average height of the Kambin’s triangle was 11.20mm±2.10mm,and the average height of the improved four corners was 11.19mm±1.93mm.The height of the improved four corners was slightly shorter than that of the Kambin’s triangle.There was a significant correlation between the two,but the difference was not statistically significant.The average bottom of Kambin’s triangle is 10.78mm±1.95mm,and the average bottom of improved four corners is 12.14mm±1.78mm.The length of the bottom edge of improved four corners is greater than that of Kambin’s triangle.There is a significant correlation between them,and the difference is statistically significant;The average area of Kambin’s triangle is 61.79mm^(2)±20.71mm^(2),and the area of improved four corners is 137.71mm^(2)±38.20mm^(2).The area of improved four corners is significantly larger than that of Kambin’s triangle.There is a significant correlation between the two,and the difference is statistically significant.Conclusion:there is a narrow right angle triangle area surrounded by traveling nerve root,dural sac and superior endplate of lower vertebral body in the lumbar intervertebral foramen.If the traveling nerve root is pulled and fixed to turn the traditional Kambin’s triangle into a quadrilateral,the bottom edge of the Kambin’s triangle area can be significantly longer and the area can be significantly expanded,which can be operated more safely.展开更多
Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatm...Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.展开更多
BACKGROUND Disc herniation(DH)is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus.It is a common cause of lumbar and leg pains.Substantial ...BACKGROUND Disc herniation(DH)is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus.It is a common cause of lumbar and leg pains.Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis,imaging,and treatment of this condition.Total endoscopic discectomy is an alternative surgical technique that is less invasive.AIM To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.METHODS This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021.All patients were randomly divided into the following two groups:The observation group,comprising 62 patients who underwent surgery using the interlaminar approach,and the control group,comprising 58 patients who were operated through the foramina approach.The treatment effects,perioperative indicators,functional recovery,pain,and quality of life were compared between the two groups.RESULTS The treatment effect in the observation group(93.55%)was significantly better than that in the control group(77.59%).There was no difference in the operative time and intraoperative blood loss amount between the two groups(P>0.05).The hospitalization time of the observation group(4.34±1.33 d)was significantly shorter than that of the control group(5.38±1.57 days)(P<0.05).The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment,but the scores were lower in the observation group than in the control group.The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment,but scores were lower in the observation group(2.18±0.88 in the lower back and 1.42±0.50 in the leg)than in the control group(3.53±0.50 in the lower back and 2.21±0.52 in the leg).A short form of the Arthritis Impact Measurement Scales 2 measurement scale(AIMS2-SF)score and Barthel index of the lower back of the two groups increased significantly after treatment,with the observation group having a significantly higher AIMS2-SF score(95.16±1.74)and Barthel index(97.29±1.75)than the control group(84.95±2.14 and 89.16±2.71,respectively)(P<0.05).CONCLUSION Through total endoscopic discectomy with the interlaminar approach,the degree of pain in the waist and leg was reduced,and the lumbar function considerably recovered.展开更多
BACKGROUND Allograft interbody spacers are utilized during transforaminal lumbar interbody fusion(TLIF) to reestablish anterior column support and disc height. While the TLIF technique offers many improvements over pr...BACKGROUND Allograft interbody spacers are utilized during transforaminal lumbar interbody fusion(TLIF) to reestablish anterior column support and disc height. While the TLIF technique offers many improvements over previous surgical methods,instrumentation and bone graft-related complications such as spacer misplacement or migration, screw fracture or misplacement, or rod breakage continue to be reported. The objective of this manuscript is to report on a fractured allograft interbody spacer that displaced into the neural foramen and resulted in impingement on the exiting nerve root that required revision.CASE SUMMARY A 50-year-old male had two-level TLIF with immediate post-operative right L5 radiculopathy. Computed tomography scan demonstrated a fractured allograft interbody spacer that displaced into the right neural foramen and impinged on the exiting L5 nerve root. Revision surgery was performed to remove the broken allograft fragments from the right L5 foramen and the intact portion of the spacer was left in place. The right leg L5 radicular pain resolved. At the last follow up 12 mo after the index procedure, computed tomography scan confirmed sound interbody and posterolateral fusion.CONCLUSION Displacement of broken allograft interbody spacer following TLIF procedures can result in neurological sequelae that require revision. To avoid such an occurrence,the authors recommend allowing sufficient time for the reconstitution of the graft in saline prior to use to decrease brittleness, to use an impactor size that is as close as possible to the spacer size and meticulous inspection of the cortical allograft spacer for any visible imperfection prior to insertion.展开更多
基金National Natural Science Foundation of China(No.82160435)。
文摘Objective:To analyze the correlation between the amplitude changes of motor evoked potential(MEP),the 3D volume changes of spinal canal measuring by postoperative CT and the improvement rate of clinical symptoms after the spinal canal decompression in minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF),and to explore the predictive value of the changes of both MEP amplitude and spinal canal volume in the assessment of long-term clinical prognosis in MIS-TLIF.Methods:A retrospective study of 68 patients with L4/5 spinal stenosis treated with MIS-TLIF was performed.The changes of both intraoperative MEP amplitude and 3D spinal canal volume during the spinal canal decompression,as well as the visual analogue scale(VAS)and Oswestry dysfunction index(ODI)scores in the long-term follow-up were all recorded.Results:The values of intraoperative MEP amplitude was 159.04%higher in 68 patients with MIS-TLIF after spinal canal decompression(P<0.01).The 3 postoperative 3D spinal canal volume(4.89±1.27)cm increased by 31.22%in comparison 3 with preoperative date(3.78±1.08)cm(P<0.01).The VAS and ODI scores were improved to 78.55%and 80.60%,respectively at the last follow-up(P<0.01).The improvement rate of MEP amplitude on the decompression side was positively correlated with the improvement rate of postoperative spinal canal volume(r=0.272,P=0.025).The improvement rate of postoperative spinal canal volume was positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.656,r=0.490,P<0.01).Moreover,the improvement rate of MEP amplitude on the decompression side was also positively correlated with the improvement rate of VAS and ODI at the last follow-up(r=0.322 and 0.235,respectively,P<0.05).Conclusion:The increase of MEP amplitude after spinal canal decompression in patients with lumbar spinal stenosis treated by MIS-TLIF was closely correlated with both of the increase of spinal canal volume and the improvement of clinical symptoms.Therefore,MEP amplitude monitoring was not only the one of the important monitoring methods for predicting the prognosis of MIS-TLIF but also the reliably predictive value in the long-term clinical prognosis in MIS-TLIF.
文摘Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.
文摘Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.
基金the Returned Overseas Chinese Scholars Startup Fund[No.LXHG2018001]。
文摘Objective We aimed to compare the clinical and radiological outcomes of midline lumbar fusion(MIDLF)versus minimally invasive transforaminal lumbar interbody fusion(MI-TLIF)in patients with degenerative spondylolisthesis and/or stenosis in L4-L5 two years after surgery.Methods Consecutively treated patients with lumbar pathology who underwent MIDLF(n=16)and a historical control group who underwent MI-TLIF(n=34)were included.Clinical symptoms were evaluated using Oswestry Disability Index(ODI),the 36-Item Short-Form Health Survey,and visual analog scale(VAS)scores before surgery and 3,6,12,and 24 months after surgery.Results The mean operative time and hematocrit(HCT,Day 1)were significantly shorter and lower in MIDLF cases(174 min vs.229 min,P<0.001;0.34 vs.0.36,P=0.037).The MI-TLIF group showed better improvement than the MIDLF group in ODI and VAS back and leg pain at 3 months postoperatively.VAS leg pain was higher in MIDLF than in MI-TLIF cases at 6 months.At 24 months follow-up,VAS back pain was higher in MI-TLIF than in MIDLF cases(P=0.018).Conclusion MIDLF is comparable to MI-TLIF at L4-5 in clinical outcomes and fusion rates,and the results verified the meaningful advantage of using MIDLF for the elderly with osteoporosis.
文摘Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.
文摘Objective: To observe the clinical effect percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of single lumbar disc herniation. Methods: From August 2017 to June 2019, 42 patients with low lumbar single segment lumbar disc herniation were treated with percutaneous transforaminal endoscopic discectomy surgery in our hospital. The operation time, incision size, bleeding volume and hospitalization time were recorded respectively. The patients were evaluated before operation, 1 month and 6 months after operation. Visual analogue scale (VAS) and assessment were used to evaluate the lumbocrural pain. The JOA score and the Oswestry disability index (ODI) were used to evaluate the lumbar function, and the modified macnab score was used to evaluate the clinical effect in the last follow-up. Results: All the 42 patients successfully completed the operation without any other operation. There were no severe complications such as dural injury and nerve root injury. The operation time was (76.98 ± 8.58) min, the incision size was (8.45 ± 1.2) mm, the bleeding volume was (20.14 ± 2.93) ml, and the hospitalization time was (4.55 ± 1.13) d. One month and six months after the operation, the visual analogue scale (VAS), the evaluation of lumbar function (Oswestry) and the disability index (ODI) were significantly improved compared with those before the operation (P Conclusion: The treatment of low lumbar but segmental lumbar disc herniation with percutaneous intervertebral foramen, with small incision, less bleeding and quick recovery, can improve the pain and dysfunction of patients.
基金Research Project of Sichuan Provincial Health Department(No:130914).
文摘Objective:To compare the differences in pain mediators and inflammatory factors after percutaneous transforaminal endoscopic discectomy and traditional fenestration operation treatment of protrusion of lumbar intervertebral disc. Methods:80 patients with protrusion of lumbar intervertebral disc treated in our hospital between March 2013 and December 2015 were collected and divided into observation group and control group (n=40) according to randomized parallel contrast. Control group received traditional fenestration operation and observation group received percutaneous transforaminal endoscopic discectomy. Before operation and 1 week after operation, fluorescence spectrophotometry was used to determine serum pain medium levels;ELISA was used to determine pro-inflammatory factor and anti-inflammatory factor levels. Results:Before operation, differences in serum pain medium and inflammatory factor levels were not statistically significant between two groups (P>0.05). 1 week after operation, serum pain media norepinephrine (NE), dopamine (DA), 5-hydroxytryptamine (5-HT), prostaglandin E2 (PGE2) and substance P (SP) levels as well as pro-inflammatory factors interleukin-1β(IL-1β), interleukin-6 (IL-6), interleukin-18 (IL-18) and tumor necrosis factor alpha (TNF-α) levels of observation group were lower than those of control group (P<0.05) while serum anti-inflammatory factors interleukin-4 (IL-4), interleukin 10 (IL-10), soluble tumor necrosis factor receptor I (sTNF-RI) levels were higher than those of control group (P<0.05). Conclusions:Percutaneous transforaminal endoscopic discectomy can effectively treat protrusion of lumbar intervertebral disc and is more advantageous in alleviating patients’ perception of pain and reducing inflammation.
文摘Objective:To analyze the efficacy of lateral transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:A total of 44 patients with lumbar disc herniation,treated in Yancheng No.l People's Hospital from January 2019 to June 2020,were randomly divided into two groups;the 24 patients in group A were treated by lateral transforaminal endoscopic surgery,while the 20 patients in group B were treated by routine lamina fenestration and nucleus pulposus surgery.Results:The curative effect of group A(91.67%)was higher than that of group B(85.0%),P>0.05;there was no significant difference in the angle from straight leg raise between group A and group B(P>0.05);the Oswestry Disability Index(ODI)and the visual analogue scale(VAS)of group A were lower than those of group B(P<0.05);the incision length,intraoperative blood loss,and hospital stay of the patients in group A were better than those in group B,P<0.05.Conclusion:Lateral transforaminal endoscopic surgery can significantly reduce pain,improve symptoms,and help to restore normal function in the early stage for patients with lumbar disc herniation.
文摘BACKGROUND Percutaneous endoscopic lumbar discectomy(PTED)is a procedure that is commonly used to treat lumbar disc herniation and spinal stenosis.Despite its less invasiveness,this surgery is rarely used to treat spinal metastases.Percutaneous vertebroplasty(PVP)has been utilized to treat lumbar vertebral body metastases but it has not proven useful in treating sciatic patients.CASE SUMMARY A 68-year-old woman presented with low back pain and radicular symptoms.She couldn't straighten her legs because of severe pain.Computed tomography(CT)showed a mass lesion in the lung and bone destruction in the L4 vertebrae.The biopsy of the lung lesion revealed adenocarcinoma and the biopsy for L4 vertebrae revealed metastatic adenocarcinoma.PTED paired with PVP was performed on the patient due to the patient's poor overall physical state and short survival time.Transcatheter arterial embolization of vertebral tumors was performed before surgical resection to reduce excessive blood loss during the operation.The incision was scaled up with the TESSY technology.The pain was obviously relieved following the operation and no serious complications occurred.Postoperative CT showed that the decompression around the nerve root was successful,polymethyl methacrylate filling was satisfactory and the tumor tissue around the nerve root was obviously removed.During the 1-year follow-up period,the patient was in a stable condition.CONCLUSION PTED in combination with PVP is an effective and safe treatment for Lumbar single-level Spinal Column metastases with radicular symptoms.Because of the small sample size and short followup time,the long-term clinical efficacy of this method needs to be further confirmed.
文摘Objective:To study the differences in pain and inflammatory stress after percutaneous transforaminal endoscope discectomy and open fenestration discectomy.Methods: Patients with lumbar intervertebral disc herniation who underwent surgical treatment in our hospital between January 2013 and January 2017 were selected and randomly divided into two groups: Percutaneous transforaminal endoscope discectomy (PTED) group and control group. Patients in PTED group received percutaneous transforaminal endoscope discectomy, while control group received open fenestration discectomy. Serum levels of pain substances SP, NPY, PGE2 and NGF, inflammatory mediators IFN-γ, TNF-α, IL-17 and MMP3 as well as stress response substances Cor, NE, OH-, O2- and MDA of two groups of patients were determined the same day after surgery and 3 days after surgery.Results: The same day after surgery and 3 d after surgery, serum SP, NPY, PGE2, NGF, IFN-γ, TNF-α, IL-17, MMP3, Cor, NE, OH-, O2- and MDA levels of PTED group were significantly lower than those of control group. Conclusion: Percutaneous transforaminal endoscope discectomy for lumbar intervertebral disc herniation causes less postoperative pain and inflammatory stress than open fenestration discectomy.
文摘Objective:To investigate the therapeutic effect of transforaminal endoscope in patients with spinal metastases.Methods:Clinical data of 28 patients with spinal metastases admitted to our hospital from May 2015 to May 2019 were retrospectively collected.According to different surgical methods,they were divided into control group(20 cases)and experimental group(8 cases),among which control group was treated with traditional open palliative decompression,while the experimental group was treated with transforaminal endoscopic decompression.The surgery and recovery indicators were compared between the two groups,including surgery time,incision length,postoperative drainage volume,out of bed activity time,length of hospital stay,the Japanese Orthopaedic Association(JOA)scores of 7 days after surgery,pain degree,complications(wound infection,transient reduction of muscle strength,hypoproteinemia with wound drainage and delayed healing),and activity of daily living.Results:The surgery time,incision length,postoperative drainage volume,out of bed activity time,and postoperative length of hospital stay of the experimental group were all less than those of the control group,and the JOA score of 7 days after surgery was higher than that of the control group,showing statistically significant differences(P<0.05).VAS scores of the experimental group on the day 1 and day 7 after surgery were lower than those of the control group,with statistically significant differences(P<0.05).The incidence of complications in the experimental group was slightly lower than that in the control group,but the difference was not significant(P>0.05).Conclusions:Transforaminal endoscope used in suitable patients with spinal metastases can greatly reduce the incision length,soft tissue and bone tissue damages,and postoperative drainage,promote early mobilization and early discharge,and reduce a series of complications due to hemorrhage and hypoproteinemia,which has a better early clinical effect in comparison with the traditional open palliative decompression.
文摘Objective:Transforaminal endoscope was used in the treatment of thoracic disc herniation and the therapeutic effect was discussed.Methods:Sixteen patients with thoracic disc herniation admitted to our hospital from October 2018 to May 2019 were divided into control group and observation group according to the random number table method,with 8 patients in each group.The control group was treated with posterior laminectomy approach,and the observation group was treated with transforaminal endoscope.The surgery-related conditions(intraoperative blood loss,surgery time,and postoperative drainage volume),VAS score,JOA score and postoperative complications were compared and analyzed.Results:There was no statistically significant difference between the two groups in the total effective rate and preoperative VAS score(P>0.05).Compared with the control group,the observation group had shorter surgery time and incision length,less postoperative drainage volume,and higher VAS score 3 days after surgery,JOA score on day 7 after surgery,and JOA score 3 months after surgery,showing statistically significant differences(P<0.05).There was no significant difference in the complications between the two groups(X2=1.067,P=0.833).Conclusions:Transforaminal endoscope had a good clinical effect with small incision and injury in the treatment of patients with thoracic disc herniation.
文摘To evaluate the clinical outcome,effectiveness and safety of the surgical management of traumatic lumbar spondylolisthesis with transforaminal lumbar interbody fusion (TLIF) with short segmental instrumentation fixation.A retrospective review of a consecutive series of 24 patients with traumatic lumbar spondylolisthesis treated with TLIF procedure was carried out.Intraoperative spinal cord monitoring was used to confirm the peripheral neural function intact during the reduction of the spondylolisthesis.Preoperative clinical and radiographic evaluation of all cases were originally collected prospectively.Data regarding blood loss,operative time,duration of hospital stay,radiographic fusion,instrumentation failure and clinical result were collected and observed at regular follow-up periods.All patients were engaged in high-energy accidents in the lower back and 16 patients had concomitant injuries.The mean operative time was 124 min,mean blood loss was 350 mL,and mean hospital stay was 6.5 days.There were no complications such as incision infection,cerebrospinal fluide (CSF) leakage and nerve root injury and so on.All patients demonstrated a solid lumbar interbody fusion within 4 months,and no evidence of spondylolisthesis correction loss,instrumentation failure and loosing.They all were completely asymptomatic,with normal neurologic findings,and had resumed their previous level of physical activities on the final follow-up.Meticulous clinical examination and careful imaging assessment could assist an early diagonosis in cases of traumatic lumbar spondylolisthesis.Performing open reduction and the TLIF procedure as soon as possible could restore segmental stability and painless function.The TLIF procedure was a safe,effective technique to treat traumatic lumbar spondylolisthesis.
基金the National Natural Science Foundation of China(No.11972242,11632013)China Postdoctoral Science Foundation(2020M680913)Shanxi Province Medical Science and Technology Innovation Team Construction Plan(2020TD13).
文摘As a novel minimally invasive technique,percutaneous endoscopic transforaminal lumbar interbody fusion(PETLIF)has been widely used in the treatment of lumbar degenerative diseases.The purpose of this study was to analyze these two operation types’biomechanical performances of PE-TLIF and traditional minimally invasive transforaminal lumbar interbody fusion(MIS-TLIF)using the finite element(FE)method.The intact FE models of L4-L5 were established and validated based on the CT images.On this basis,the FE models of MIS-TLIF and PETLIF were established and analyzed.It is demonstrated that for lumbar interbody fusion with the oblique asymmetrically implanted cage under bilateral pedicle screws and rods fixation,such as MIS-TLIF and PE-TLIF,different degrees of articular process resection have no significant effect on the cage subsidence,and the surgical segment can achieve similar stability.In addition,the maximum stress of the L4 inferior endplate of MIS-TLIF and PE-TLIF is greater than that of the L5 superior endplate,which indicates that MIS-TLIF and PE-TLIF can cause cage subsidence in the L4 inferior endplate.
基金supported by the National Natural Science Foundation of China(No.81272024).
文摘Objective:To analyze the instrumentation-related complications of patients with lumbar degenerative disc diseases(LDD)who underwent minimally invasive transforaminal lumbar interbody fusion(MISTLIF)and to discuss the potential strategy for the control of these complications.Methods:A total of 87 patients with LDD were treated with the MIS-TLIF procedure.Complications,including malposition or breakage of guide pin,percutaneous pedicle screw(PPS)or cages,neurological deficit,and superior-level facet joint violations,were determined during and after the surgery.Computed tomography(CT)was used to evaluate the PPS accuracy and the superior-level facet joint violations.Results:A total of 386 PPSs were used.During the surgery,3(0.8%)guide pin and 1(0.3%)PPS perforated the anterior wall of the vertebral body,respectively.One(0.3%)PPS was pulled out during the reduction of slip.Malposition of the cages occurred in 6(1.6%)PPSs.These were all adjusted accordingly during the surgery.All the patients received>2 years of follow-up.No loosening or breakage of PPS and cage was observed,but CT showed 27(7.0%)PPSs misplaced.No neurological deficit related to misplaced PPS was observed.The total facet joint violation(FJV)rate was 36.2%,with grade 2 and grade 3 violations is 21(12.1%)and 6(3.4%),respectively.Conclusion:MIS-TLIF has similar instrumentation-related complications with open TLIF.Accurate preoperative evaluation and improved surgical techniques can effectively reduce these instrumentation-related complications.
文摘Background:The prevalence of low back pain with radiculopathy in general population varies from 9.9%to 25%,which can be due to bony narrowing of the lateral recess or due to prolapsed intervertebral disc.Transforaminal epidural injection of a mixture of long-acting anaesthetic(bupivacaine)and particulate steroids(depomedrol)has been a treatment modality in patients not responding to initial physiotherapy and neuropathic pain medications.Methods:To analyze the effectiveness of transforaminal epidural steroid injection(TFESI)in the treatment of low back pain with radiculopathy,a retrospective case series evaluating the records of patients that received TFESI(1 mL 0.5%bupivacaine+1 ml/40 mg depomedrol)under C-arm guidance from January 2015 to December 2018(3 years)at Upendra Devkota Memorial-National Institute of Neurological and Allied Sciences(UDM-NINAS),their lumbosacral MRI and the pre-procedure,1-week and 3-month numeric pain rating scale,were analyzed.Successful treatment(reduction of pain scale by more than 50%of baseline at 3 months)in the patients with bony recess stenosis and those with prolapsed intervertebral disc was compared.Results:Out of 67 patients that received TFESI,35(52.23%)could be followed up.The mean age was 55.8±14.39 years and 51.3%were females.68.57%had L5 and 20%had S1 radiculopathy.Bony recess stenosis was seen in the aged 40%and PIVD was the cause of radiculopathy in 60%.The median duration of radicular pain prior to intervention was 3 months.TFESI was effective as the mean numeric pain scale before injection was 8.97±1.32 which reduced to 3.91±3.23(paired t test p value<0.001)at 1 week post injection and 3.23±3.34(paired t test p value<0.001)at 3 months post injection.Twenty-six of the 35 patients(75.29%)had more than 50%pain relief compared to baseline at 3 months and were satisfied.Nine patients continued to have pain;however,only one required a surgical intervention.The effectiveness of TFESI was not significantly different in different ages(Fisher’s exact test p value 0.182)and in different anatomic levels(Fisher’s exact test p value 0.241).Six out of eight patients with bony recess stenosis benefited as compared to 14 out of 19 patients with PIVD,though it was not statistically significant(Fischer’s exact test p value 0.688).There were no adverse events recorded.Conclusion:TFESI is a safe and efficacious treatment modality in patients with radicular low back pain especially in aged patients in whom surgery under general anaesthesia is not free from risk.
基金Hainan Provincial Natural Science Foundation(No.819QN365)National Natural Science Foundation of China(No.81902270)。
文摘Objective:We through the anatomy of cadavers to study the"Kambin’s triangle"in the safe working area of lumbar intervertebral foramen and to provide anatomical reference for clinical lumbar fusion through Kambin’s triangle approach.Methods:five complete cadaveric specimens were taken,the soft tissue of the lumbar back was removed,the transverse process,upper and lower articular processes and part of the vertebral lamina were bitten,the Kambin’s triangle area of the lumbar spine was completely exposed,the bottom edge and height of the Kambin’s triangle were measured,and the area of the Kambin’s triangle was calculated;Using Kirschner wire,pull and fix the traveling nerve root to make the Kambin’s triangle into a rectangle,measure the length of the bottom edge and height again,calculate the area,and compare the two groups of data.Results:the average height of the Kambin’s triangle was 11.20mm±2.10mm,and the average height of the improved four corners was 11.19mm±1.93mm.The height of the improved four corners was slightly shorter than that of the Kambin’s triangle.There was a significant correlation between the two,but the difference was not statistically significant.The average bottom of Kambin’s triangle is 10.78mm±1.95mm,and the average bottom of improved four corners is 12.14mm±1.78mm.The length of the bottom edge of improved four corners is greater than that of Kambin’s triangle.There is a significant correlation between them,and the difference is statistically significant;The average area of Kambin’s triangle is 61.79mm^(2)±20.71mm^(2),and the area of improved four corners is 137.71mm^(2)±38.20mm^(2).The area of improved four corners is significantly larger than that of Kambin’s triangle.There is a significant correlation between the two,and the difference is statistically significant.Conclusion:there is a narrow right angle triangle area surrounded by traveling nerve root,dural sac and superior endplate of lower vertebral body in the lumbar intervertebral foramen.If the traveling nerve root is pulled and fixed to turn the traditional Kambin’s triangle into a quadrilateral,the bottom edge of the Kambin’s triangle area can be significantly longer and the area can be significantly expanded,which can be operated more safely.
文摘Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.
基金Science and Technology Support Plan of Guizhou Science and Technology Department,No.[2019]2812and National Natural Science Foundation of China,No.82060415.
文摘BACKGROUND Disc herniation(DH)is a fragment of the disc nucleus that is pushed out of the annulus into the spinal canal due to a tear or rupture in the annulus.It is a common cause of lumbar and leg pains.Substantial advancements have been made to determine the cause of DH and to ensure accurate diagnosis,imaging,and treatment of this condition.Total endoscopic discectomy is an alternative surgical technique that is less invasive.AIM To study the optimal approach for a total endoscopic discectomy and its influence on lumbar and leg function in DH patients.METHODS This prospective study enrolled 120 patients with lumbar DH who were treated in our hospital from February 2018 to January 2021.All patients were randomly divided into the following two groups:The observation group,comprising 62 patients who underwent surgery using the interlaminar approach,and the control group,comprising 58 patients who were operated through the foramina approach.The treatment effects,perioperative indicators,functional recovery,pain,and quality of life were compared between the two groups.RESULTS The treatment effect in the observation group(93.55%)was significantly better than that in the control group(77.59%).There was no difference in the operative time and intraoperative blood loss amount between the two groups(P>0.05).The hospitalization time of the observation group(4.34±1.33 d)was significantly shorter than that of the control group(5.38±1.57 days)(P<0.05).The Japanese Orthopaedic Association and Oswestry Disability Index scores decreased significantly in both groups after treatment,but the scores were lower in the observation group than in the control group.The visual analog scale scores of the lower back and legs of the two groups were significantly reduced after treatment,but scores were lower in the observation group(2.18±0.88 in the lower back and 1.42±0.50 in the leg)than in the control group(3.53±0.50 in the lower back and 2.21±0.52 in the leg).A short form of the Arthritis Impact Measurement Scales 2 measurement scale(AIMS2-SF)score and Barthel index of the lower back of the two groups increased significantly after treatment,with the observation group having a significantly higher AIMS2-SF score(95.16±1.74)and Barthel index(97.29±1.75)than the control group(84.95±2.14 and 89.16±2.71,respectively)(P<0.05).CONCLUSION Through total endoscopic discectomy with the interlaminar approach,the degree of pain in the waist and leg was reduced,and the lumbar function considerably recovered.
文摘BACKGROUND Allograft interbody spacers are utilized during transforaminal lumbar interbody fusion(TLIF) to reestablish anterior column support and disc height. While the TLIF technique offers many improvements over previous surgical methods,instrumentation and bone graft-related complications such as spacer misplacement or migration, screw fracture or misplacement, or rod breakage continue to be reported. The objective of this manuscript is to report on a fractured allograft interbody spacer that displaced into the neural foramen and resulted in impingement on the exiting nerve root that required revision.CASE SUMMARY A 50-year-old male had two-level TLIF with immediate post-operative right L5 radiculopathy. Computed tomography scan demonstrated a fractured allograft interbody spacer that displaced into the right neural foramen and impinged on the exiting L5 nerve root. Revision surgery was performed to remove the broken allograft fragments from the right L5 foramen and the intact portion of the spacer was left in place. The right leg L5 radicular pain resolved. At the last follow up 12 mo after the index procedure, computed tomography scan confirmed sound interbody and posterolateral fusion.CONCLUSION Displacement of broken allograft interbody spacer following TLIF procedures can result in neurological sequelae that require revision. To avoid such an occurrence,the authors recommend allowing sufficient time for the reconstitution of the graft in saline prior to use to decrease brittleness, to use an impactor size that is as close as possible to the spacer size and meticulous inspection of the cortical allograft spacer for any visible imperfection prior to insertion.
