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Medicina (Kaunas, Lithuania) Jul 2023: Degenerative disk disease is a widespread chronic condition that causes diskogenic pain. Diskogenic pain can be treated with various therapy methods. Disc-FX is a... (Review)
Review
: Degenerative disk disease is a widespread chronic condition that causes diskogenic pain. Diskogenic pain can be treated with various therapy methods. Disc-FX is a revolutionary, minimally invasive, percutaneous nucleo-annuloplasty method that combines manual diskectomy with nuclear and annular remodeling using radiofrequency ablation to relieve diskogenic pain. In this study, the technical features, clinical outcomes, and complications of Disc-FX are summarized. : A comprehensive literature review was performed. By exploring several databases, we collected studies on Disc-FX for treating diskogenic pain. The outcomes included perioperative data, clinical results, and complications. : In the 15 studies included, data from 570 patients were collected. L4-L5 was the most frequently operated level, and most cases underwent single-level procedures. The follow-up period for these patients ranged from 2 months to 24 months. One study reported a procedure time between 35 and 60 min, whereas the remaining studies reported a procedure time of less than 30 min. The mean visual analog scale score decreased from 7.22 preoperatively to 1.81 at the final follow-up. The mean numerical rating scale score decreased from 6.98 preoperatively to 3.9 at the final follow-up. The mean Japanese Orthopaedic Association score improved from 16.26 preoperatively to 25.88 in the final follow-up. The mean Oswestry Disability Index score decreased from 35.37 preoperatively to 14.66 at the final follow-up. The mean satisfaction rate (based on the Macnab criteria) was 87.6% (range, 78.4-95.2%). The total incidence of postoperative transient pain was 8.77% (50/570) after nucleo-annuloplasty using Disc-FX, and recurrence was 1.58% (9/570). : According to our comprehensive evaluation, using percutaneous nucleo-annuloplasty for treating lumbar diskogenic diseases provided considerable pain alleviation and improved functional outcomes with fewer complications. Disc-FX is a safe and effective procedure that is a good treatment option for patients with diskogenic pain.
Topics: Humans; Treatment Outcome; Diskectomy; Low Back Pain; Chronic Disease; Radiofrequency Ablation; Lumbar Vertebrae; Retrospective Studies; Endoscopy
PubMed: 37512102
DOI: 10.3390/medicina59071291 -
Neurosurgical Focus Sep 2023
Topics: Humans; Diskectomy
PubMed: 37657111
DOI: 10.3171/2023.6.FOCUS23449 -
World Neurosurgery Jan 2024Cervical radiculopathy is a common and disabling cervical condition characterized by symptoms including axial neck pain, radicular pain, weakness, and numbness in one or... (Review)
Review
Cervical radiculopathy is a common and disabling cervical condition characterized by symptoms including axial neck pain, radicular pain, weakness, and numbness in one or both arms. Common causes include herniated discs and foraminal stenosis, often accompanied by varying degrees of degenerative disc disease and uncovertebral joint hypertrophy. In the treatment of cervical radiculopathy, there is an increasing preference for posterior foraminotomy over anterior cervical discectomy and fusion due to the avoidance of fusion-related complications. As endoscopic spine surgery techniques continue to evolve, there is a rising interest in posterior endoscopic cervical foraminotomy and posterior endoscopic cervical discectomy as effective treatments for cervical radiculopathy. Because these procedures can performed through a single subcentimeter incision with minimal soft tissue damage, they can often be carried out as ambulatory procedures. In this narrative review, we examined current literature addressing the indications, surgical techniques, outcomes, and potential complications associated with posterior cervical endoscopic approaches.
Topics: Humans; Foraminotomy; Radiculopathy; Cervical Vertebrae; Diskectomy; Intervertebral Disc Displacement; Treatment Outcome; Retrospective Studies
PubMed: 37821026
DOI: 10.1016/j.wneu.2023.10.021 -
BMC Musculoskeletal Disorders Sep 2023In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is...
In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is increasing yearly. No clinical studies have reported the use of percutaneous endoscopic lumbar discectomy (PELD) in obese adolescent lumbar disc herniation (ALDH) patients. This study evaluated the preliminary surgical outcomes of PELD in obese ALDH patients. Fifty-one ALDH patients underwent single-level PELD surgery between January 2014 and January 2020. Patients were divided into an obese group and a normal group. Patient characteristics and surgical variables were compared between the two groups. The VAS, ODI, and SF-36 scales were used preoperatively and postoperatively to evaluate the clinical efficacy. In this study, 19 patients were included in the obese group, and 28 were included in the normal group. There was no significant difference in age, sex, duration of low back pain, duration of leg pain, or operative level between the obese and normal groups preoperatively. The obese group had a longer operative time (OT) (101.9 ± 9.0 min vs. 84.3 ± 11.0 min, P < 0.001), more fluoroscopy exposures (41.0 ± 5.8 vs. 31.6 ± 7.0, P < 0.001) and a longer time to ambulation (29.9 ± 4.0 vs. 25.0 ± 2.9, p < 0.001) than the normal group. The groups did not significantly differ in complications. The VAS score for back and leg pain and the ODI and SF-36 score for functional status improved significantly postoperatively. The PELD procedure is a safe and feasible method for treating LDH in obese adolescents. Obese ALDH patients require a longer OT, more fluoroscopy exposures and a longer time to get out of bed than normal ALDH patients. However, PELD yields similar clinical outcomes in obese and normal ALDH patients.
Topics: Adolescent; Humans; Diskectomy, Percutaneous; Pediatric Obesity; Intervertebral Disc Displacement; Lumbar Vertebrae; Diskectomy; Low Back Pain
PubMed: 37674144
DOI: 10.1186/s12891-023-06842-8 -
European Spine Journal : Official... Jun 2024To determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.
PURPOSE
To determine the impact of poor mental health on patient-reported and surgical outcomes after microdiscectomy.
METHODS
Patients ≥ 18 years who underwent a single-level lumbar microdiscectomy from 2014 to 2021 at a single academic institution were retrospectively identified. Patient-reported outcomes (PROMs) were collected at preoperative, three-month, and one-year postoperative time points. PROMs included the Oswestry Disability Index (ODI), Visual Analog Scale Back and Leg (VAS Back and VAS Leg, respectively), and the mental and physical component of the short form-12 survey (MCS and PCS). The minimum clinically important differences (MCID) were employed to compare scores for each PROM. Patients were categorized as having worse mental health or better mental health based on a MCS threshold of 50.
RESULTS
Of 210 patients identified, 128 (61%) patients had a preoperative MCS score ≤ 50. There was no difference in 90-day surgical readmissions or spine reoperations within one year. At 3- and 12-month time points, both groups demonstrated improvements in all PROMs (p < 0.05). At three months postoperatively, patients with worse mental health had significantly lower PCS (42.1 vs. 46.4, p = 0.004) and higher ODI (20.5 vs. 13.3, p = 0.006) scores. Lower mental health scores were associated with lower 12-month PCS scores (43.3 vs. 48.8, p < 0.001), but greater improvements in 12-month ODI (- 28.36 vs. - 18.55, p = 0.040).
CONCLUSION
While worse preoperative mental health was associated with lower baseline and postoperative PROMs, patients in both groups experienced similar improvements in PROMs. Rates of surgical readmissions and reoperations were similar among patients with varying preoperative mental health status.
Topics: Humans; Diskectomy; Male; Female; Middle Aged; Adult; Retrospective Studies; Patient Reported Outcome Measures; Treatment Outcome; Lumbar Vertebrae; Aged; Mental Health
PubMed: 38630247
DOI: 10.1007/s00586-023-08090-9 -
Pain Physician Nov 2023Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery... (Clinical Trial)
Clinical Trial
Comparison of Percutaneous Endoscopic Transforaminal and Interlaminar Approaches in Treating Adjacent Segment Disease Following Lumbar Decompression Surgery: A Clinical Retrospective Study.
BACKGROUND
Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery (PELD) has been used to treat ASD through either a transforaminal or interlaminar approach. However, to our limited knowledge there are no reports comparing the 2 approaches for treating ASD.
OBJECTIVE
To evaluate clinical outcomes of PELD in treating ASD and comparing the surgical results and complications between the 2 approaches. This may be helpful for spinal surgeons when decision-making ASD treatment.
STUDY DESIGN
A clinical retrospective study.
SETTING
This study was conducted at the Department of Orthopedics of the Affiliated Hospital of Qingdao University.
METHODS
From January 2015 through December 2019, a total of 68 patients with ASD who underwent PELD after lumbar posterior decompression with fusion surgery were included in this study. The patients were divided into a percutaneous endoscopic transforaminal decompression (PETD) group and a percutaneous endoscopic interlaminar decompression (PEID) group according to the approach used. The demographic characteristics, radiographic and clinical outcomes, and complications were recorded in both groups through a chart review.
RESULTS
Of the 68 patients, 40 underwent PEID and 28 patients underwent PETD. Compared with their preoperative Visual Analog Scale (VAS) pain score and Oswestry Disability Index (ODI) score, all patients had significant postoperative improvement at 3 months, 6 months, one year and at the latest follow-up. There were no significant statistical differences in the VAS and ODI scores between PETD and PEID groups with a P value > 0.05. There was a significant statistical difference in the average fluoroscopy times between the PETD and PEID groups with a P value = 0.000. Revision surgery occurred in 8 patients: 6 patients who underwent PETD and 2 patients who underwent PEID. The revision rate showed a significant statistical difference between the 2 approaches with a P value = 0.039.
LIMITATIONS
Firstly, the number of patients included in this study was small. More patients are needed in a further study. Secondly, the follow-up time was limited in this study. There is still no conclusion about whether the primary decompression with instruments will increase the reoperation rate after a PELD, and a longer follow-up is needed in the future. Thirdly, this study was a clinical retrospective study. Randomized or controlled trials are needed in the future in order to achieve a higher level of evidence. Fourthly, there were debates about PELD approach choices for ASDs, which may affect the comparison results between PETD and PEID. In our study, the approaches were mainly determined by the level and types of disc herniation, and the surgeons' preference. More patients with an ASD with different levels and types of disc herniation and surgical approaches are needed in the future to eliminate these biases.
CONCLUSION
Percutaneous endoscopic lumbar decompression surgery is a feasible option for ASD following lumbar decompression surgery with instruments. Compared with PETD, PEID seems to be a better approach to treat symptomatic ASDs.
Topics: Humans; Decompression; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 37976490
DOI: No ID Found -
World Neurosurgery Dec 2023Cervical microendoscopic laminoforaminotomy (MELF) has been proven to be an effective, motion preserving procedure for the surgical treatment of cervical radiculopathy....
OBJECTIVE
Cervical microendoscopic laminoforaminotomy (MELF) has been proven to be an effective, motion preserving procedure for the surgical treatment of cervical radiculopathy. Cervical 4 (C4) radiculopathies are often unrecognized by the initial evaluating physician and may be misdiagnosed as axial neck pain. In this study, we compare MELF to anterior cervical disk fusion (ACDF) for C4 radiculopathy in the largest series of minimally invasive foraminotomy for C4 radiculopathy to date.
METHODS
This is a single-institution retrospective chart review of 42 cases for C4 radiculopathy, 21 MELF and 21 ACDF. Primary outcome measures were length of surgery, length of hospital stay, and time to return to work. Secondary outcome measures were visual analog scale (VAS) neck pain and reoperation rate.
RESULTS
All patients were diagnosed with a unilateral C4 radiculopathy using magnetic resonance imaging or steroid injections. The length of surgery and length of hospital stay were significantly decreased in the MELF group compared with ACDF. VAS neck pain significantly decreased for patients in both groups, but the difference between MELF and ACDF was not statistically significant. There were no major complications. No patient underwent revision at the index level or adjacent levels in the MELF group.
CONCLUSIONS
We demonstrate that C4 radiculopathy can be identified with appropriate history, physical examination, and targeted nerve root injections. When identified, these radiculopathies that fail conservative therapy can be effectively treated with cervical microendoscopic laminoforaminotomy, with comparable outcomes to ACDF. The length of surgery and length of stay are reduced when compared with ACDF.
Topics: Humans; Radiculopathy; Neck Pain; Treatment Outcome; Retrospective Studies; Diskectomy; Cervical Vertebrae; Spinal Fusion; Foraminotomy; Spinal Diseases
PubMed: 37806518
DOI: 10.1016/j.wneu.2023.10.015 -
European Spine Journal : Official... Feb 2024This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed.
PURPOSE
This systematic review aims to investigate the complication rate of endoscopic spine surgeries, stratifying them by technique, district and kind of procedure performed.
METHODS
This study was conducted according to the PRISMA statement. The literature search was conducted in MEDLINE, CINAHL, EMBASE, Cochrane Register, OTseeker and ScienceDirect database. Types of studies included were observational studies (cohort studies, case-control studies and case series) and randomised or quasi-randomised clinical with human subjects. No restrictions on publication year were applied. Repeated articles, reviews, expert's comments, congress abstracts, technical notes and articles not in English were excluded. Several data were extracted from the articles. In particular, data of perioperative (≤ 3 months) and late (> 3 months) complications were collected and grouped according to: (1) surgical technique [uniportal full-endoscopic spine surgery (UESS) or unilateral biportal endoscopic spine surgery (UBESS)]; (2) spinal district treated [cervical, thoracic or lumbar] and (3) type of procedure [discectomy/decompression or fusion]. Complication analysis was performed in subgroups with at least 100 patients to have clinically meaningful statistical validity.
RESULTS
A total of 117 full-text articles were assessed for eligibility. Of the 117 records included, 95 focused their research on UESS (14 LOE V, 33 LOE IV, 43 LOE III and five LOE II) and 23 on UBESS (three LOE V, eight LOE IV, 10 LOE III and two LOE II). A total of 20,020 patients were extracted to investigate the incidence of different perioperative and late complications, 10,405 for UESS and 9615 for UBESS.
CONCLUSION
The present study summarises the complications reported in the literature for spinal endoscopic procedures. On the one hand, the most relevant described were perioperative complications (transient neurological deficit, dural tear and dysesthesia) that are especially meaningful for endoscopic discectomy and decompression. On the other hand, late complications, such as mechanical implant failure, are more common in endoscopic interbody fusion.
LEVEL OF EVIDENCE
I.
Topics: Humans; Databases, Factual; Diskectomy; Endoscopy; Lumbosacral Region; Spine
PubMed: 37587257
DOI: 10.1007/s00586-023-07891-2 -
Spine Jul 2023Prior literature has demonstrated that disparities exist in health care access and outcomes by insurance status, and patients with commercial plans fare better than...
INTRODUCTION
Prior literature has demonstrated that disparities exist in health care access and outcomes by insurance status, and patients with commercial plans fare better than those with Medicaid. However, variation may exist within commercial plans, which may impact care access. The purpose of our study was to determine the association between commercial health insurance plan type and access/time to surgery among patients with degenerative cervical conditions.
METHODS
The MarketScan database (IBM Watson Health, Ann Arbor, MI) was utilized to identify the first instance of International Classification of Diseases-10-CM diagnosis codes for cervical myelopathy and radiculopathy. Patients 65 years old or below enrolled from 2015 to 2020 with a minimum of two years of continuous enrollment were included. Surgery for myelopathy included anterior cervical discectomy and fusion (ACDF), posterior cervical laminectomy and fusion, and laminoplasty, whereas surgery for radiculopathy included ACDF, cervical disk arthroplasty, and foraminotomy. The time between first diagnosis and surgery was determined. Insurance plan type was categorized as noncapitated (NC), non-high-deductible health plan, Health Management Organization-type partially or fully capitated plans, or high-deductible health plans (HDHP). Proportional hazards regression was utilized to compare time-to-incidence of surgery by plan type, adjusting for age, and sex.
RESULTS
In total, 55,954 patients with cervical myelopathy and 705,117 patients with cervical radiculopathy were included. Mean follow-up was 537 and 657 days for myelopathy and radiculopathy, respectively. At two years postdiagnosis, 22.6% of myelopathy and 5.6% of radiculopathy patients were managed surgically. ACDF was the most common surgery for both myelopathy (85.7% of surgically managed patients) and radiculopathy (80.6%). The mean time to surgery for myelopathy was 101 days, and 196 days for radiculopathy. The most common plan type was NC for both myelopathy (81.5%, n=44,832) and radiculopathy (80.6%, n=559,109). Time-to-occurrence of surgery was significantly higher among both myelopathy and radiculopathy patients with capitated plans and HDHP versus NC plans, but the impact was significantly greater among those with radiculopathy than myelopathy (all P <0.05).
CONCLUSIONS
Insurance plan structure has a significant impact on incidence of and on time-to-occurrence of surgery for patients with cervical degenerative conditions. Patients with HDHP plans may experience higher costs, potentially limiting access to care.
Topics: Humans; Aged; Radiculopathy; Treatment Outcome; Spinal Fusion; Cervical Vertebrae; Diskectomy; Spinal Cord Diseases; Insurance Coverage
PubMed: 36395378
DOI: 10.1097/BRS.0000000000004543 -
Spine Sep 2023A retrospective analysis.
STUDY DESIGN
A retrospective analysis.
OBJECTIVE
The aim of our study was to analyze the association of Area Deprivation Index (ADI) with the utilization and costs of elective anterior cervical discectomy and fusion (ACDF) surgery.
SUMMARY OF BACKGROUND DATA
ADI, a comprehensive neighborhood-level measure of socioeconomic disadvantage, has been shown to be associated with worse perioperative outcomes in a variety of surgical settings.
MATERIALS AND METHODS
The Maryland Health Services Cost Review Commission Database was queried to identify patients who underwent primary elective ACDF between 2013 and 2020 in the state. Patients were stratified into tertiles by ADI, from least disadvantaged (ADI1) to most disadvantaged (ADI3). The primary endpoints were ACDF utilization rates per 100,000 adults and episode-of-care total costs. Univariable and multivariable regression analyses were performed.
RESULTS
A total of 13,362 patients (4984 inpatient and 8378 outpatient) underwent primary ACDF during the study period. In our study, there were 2,401 (17.97%) patients residing in ADI1 neighborhoods (least deprived), 5974 (44.71%) in ADI2, and 4987 (37.32%) in ADI3 (most deprived). Factors associated with increased surgical utilization were increasing ADI, outpatient surgical setting, non-Hispanic ethnicity, current tobacco use, and diagnoses of obesity and gastroesophageal reflux disease. Factors associated with lower surgical utilization were: non-white race, rurality, Medicare/Medicaid insurance status, and diagnoses of cervical disk herniation or myelopathy. Factors associated with higher costs of care were increasing ADI, older age, Black/African American race, Medicare or Medicaid insurance, former tobacco use, and diagnoses of ischemic heart disease and cervical myelopathy. Factors associated with lower costs of care were outpatient surgical setting, female sex, and diagnoses of gastroesophageal reflux disease and cervical disk herniation.
CONCLUSIONS
Neighborhood socioeconomic deprivation is associated with increased episode-of-care costs in patients undergoing ACDF surgery. Interestingly, we found greater utilization of ACDF surgery among patients with higher ADI.
LEVEL OF EVIDENCE
3.
Topics: Adult; Humans; Female; Aged; United States; Retrospective Studies; Spinal Fusion; Intervertebral Disc Displacement; Medicare; Spinal Cord Diseases; Diskectomy; Gastroesophageal Reflux; Socioeconomic Factors; Cervical Vertebrae
PubMed: 37417689
DOI: 10.1097/BRS.0000000000004769