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Turkish Neurosurgery 2022To report the clinical outcomes of microdiscectomy (MD) and endoscope assisted discectomy (EAD) techniques via the posterior approach in patients with cervical disc...
AIM
To report the clinical outcomes of microdiscectomy (MD) and endoscope assisted discectomy (EAD) techniques via the posterior approach in patients with cervical disc herniations (CDHs).
MATERIAL AND METHODS
The data were obtained from retrospective review of the patient?s charts and the latest follow-up examination.
RESULTS
A total of 83 cases with CDH who were treated by posterior cervical discectomy (PCD), between 2010 and 2019, were reviewed. MD was used in 42 patients (male: 20, female: 22) with a mean age of 51.1 years. In MD group, all patients had pain, and 26 of them had additional weakness. Visual analogue scale (VAS) neck score was 7.72, VAS arm score was 8.83; PROLO score was 7.41. EAD was used in 41 patients (male: 26, female: 15) with a mean age of 38.7 years. In EAD group, all patients had pain, and 20 of them had additional weakness. VAS neck and arm scores were 7.75, and 8.72, respectively; PROLO score was 7.44. Mean follow-up time was 24.7 months. The scores at the latest exam are as follows: in MD group, VAS score for neck was 2.32, for arm 1.11; PROLO score was 9.58; in EAD group, VAS score for neck was 2.18 and for arm 0.97; PROLO score was 9.66. Both surgical techniques were success with statically significance (p?0.05) according to the scores.The techniques were equally effective while postoperative VAS (p > 0.412) and PROLO (p > 0.980) scores were similar in both groups.
CONCLUSION
Both approaches are effective for selected patients with soft cervical disc herniation in which settled lateral location. Both techniques allow working with two handle, therefore facilitating the gentle manipulation that can obtain for avoiding hazardous effect to spinal cord and nerve root.
Topics: Adult; Cervical Vertebrae; Diskectomy; Endoscopes; Female; Foraminotomy; Humans; Intervertebral Disc Displacement; Male; Middle Aged; Neck Pain; Retrospective Studies; Treatment Outcome
PubMed: 35147966
DOI: 10.5137/1019-5149.JTN.34918-21.2 -
Neurologia Medico-chirurgica Jan 2020For full-endoscopic lumbar discectomy, operating costs are also important because expensive equipment are necessary. We surveyed the operating costs of surgical...
For full-endoscopic lumbar discectomy, operating costs are also important because expensive equipment are necessary. We surveyed the operating costs of surgical equipment necessary for full-endoscopic surgery together with surgical procedure reimbursement fees. A total of 295 cases of full-endoscopic surgery via a transforaminal approach were retrospectively analyzed. We calculated the frequency of damage and the unit purchase price of devices such as endoscopes, and surgical instruments such as grasping forceps for nucleotomy, high-speed drill bar, and bipolar forceps, and examined the operating costs in Japanese yen against the procedure fee per case. Endoscope breakage occurred seven times, and a payment of ¥760,000 was necessary for trade-in and purchase of a new endoscope. The total breakage number of grasping forceps was 58, and the purchase price per unit was ¥116,000. Therefore, a total of ¥12,020,000 was required for the 295 cases, and the calculated operating cost that accompanies equipment breakage was ¥40,000 per case. In addition, about ¥118,000 was required for disposable bipolar forceps and high-speed drill bar to be used intraoperatively for each case. Thus, for one case it is calculated that total ¥158,000 is utilized for equipment from the surgical reimbursement fee per case specified by the Japanese Ministry of Health being ¥303,900. Minimally invasive procedures provide great benefit to patients; however, the eventual contribution to hospital profits is small and may not be sufficient. To resolve this issue, the cost of surgical equipment should be lowered and/or the surgical reimbursement fee of the full-endoscopic surgery should be raised.
Topics: Diskectomy; Endoscopes; Endoscopy; Equipment Failure; Humans; Insurance, Health, Reimbursement; Intervertebral Disc Displacement; Japan; Lumbar Vertebrae; Surgical Equipment; Surgical Instruments
PubMed: 31619601
DOI: 10.2176/nmc.oa.2019-0139 -
World Neurosurgery Jul 2021To compare and analyze efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar discectomy (OLD) for adolescent lumbar disc herniation. (Comparative Study)
Comparative Study
OBJECTIVE
To compare and analyze efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar discectomy (OLD) for adolescent lumbar disc herniation.
METHODS
Clinical data of 257 patients with single-segment adolescent lumbar disc herniation who underwent surgical treatment from January 2015 to December 2019 were retrospectively collected. The patients were divided into PELD and OLD groups based on the surgical method used. Propensity score matching was performed using preoperative baseline data of patients in both groups, and some patients in both groups were selected for comparative study. Clinical and follow-up data were assessed and compared.
RESULTS
There was no statistically significant difference in preoperative baseline data between the 2 groups of patients after propensity score matching. Visual analog scale and Oswestry Disability Index scores improved in both groups postoperatively and at each follow-up time point (P < 0.05). However, visual analog scale scores on the first postoperative day and Oswestry Disability Index scores at 3 months postoperatively were lower in the PELD group than in the OLD group (P < 0.05). Duration of surgery, intraoperative blood loss, and duration of postoperative hospitalization were lower in the PELD group than in the OLD group (P < 0.05). There was no statistically significant difference between the 2 groups when comparing complication and recurrence rates (P >0.05).
CONCLUSIONS
Both PELD and OLD are effective and safe surgical techniques for treatment of adolescent lumbar disc herniation. However, compared with OLD, PELD is more advantageous for rapid symptom relief and improving postoperative quality of life with a low rate of complications and recurrence.
Topics: Adolescent; Diskectomy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 33989822
DOI: 10.1016/j.wneu.2021.05.007 -
Scientific Reports Aug 2022Percutaneous laser discectomy is one common and effective treatment for cervical radicular pain. Currently, the surgery is performed with blind cannulation technique,...
Percutaneous laser discectomy is one common and effective treatment for cervical radicular pain. Currently, the surgery is performed with blind cannulation technique, mainly relies on the experience of surgeon. However, it still remains unsafe and difficult to reach the target. As an alternative, ultrasound-guided cannulation provides visualization of important structures, thus increasing the precision and safety. The primary goal of this study is to report the detail of the ultrasound-guided technique in the percutaneous laser cervical discectomy. The secondary purpose is to evaluate the feasibility of the novel therapy. This is a single center, feasibility study conducted in one teaching hospital. Thirteen intervertebral discs in 9 patients presented with cervical radicular pain. Accuracy of the cannulation with ultrasonic guidance was confirmed by the anterior-posterior and lateral view of fluoroscopy. We compared the pain severity pre- and post-treatment with Visual Analogue Score (VAS), and functional improvement was assessed with the modified Macnab Criteria and Neck Disability Index (NDI) respectively. Ultrasonic short-axis was used to scan the cervical nerve root, and its transition was used to identify the distinct intervertebral space. Following the recognition of targeted cervical level, the ultrasound probe was moved medially for the visualization of the surface of the cervical vertebrae. In plane cannulation was then applied to avoid the injury of the vessels. The location of cannula was confirmed by the fluoroscopic imaging. Low-power laser was set for the cervical disc ablation in this cohort. The majority of the surgical sites maintained in the C5/6 level (38%), and 31% for the C6/7 level respectively. Despite the distinct cervical level, the tip of needle was properly placed near by the targeted intervertebral disc in all participants, which was confirmed by the imaging of fluoroscopy. We did not observe any obvious complications during the procedure. The mean VAS decreased from 7.6 ± 1.1 to 2.3 ± 2.7 one month after discharge, and 2.1 ± 2.6 at the last follow-up (median duration of nine months). All patients reported significant improvement of NDI up to last follow-up (p = 0.011). Meanwhile, the good to excellent rate was reported in 8 of 9 patients (89%) according to the modified Macnab Criteria. The finding of this feasibility assessment indicates the ultrasound-based cannulation technique is capable of guiding the cannulation for the percutaneous laser discectomy. It may facilitate identifying the corresponding site of cervical intervertebral disc and prevent the damage of vessel.
Topics: Cervical Vertebrae; Diskectomy; Feasibility Studies; Humans; Intervertebral Disc Displacement; Lasers; Neck Pain; Radiculopathy; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional
PubMed: 35918378
DOI: 10.1038/s41598-022-17627-9 -
BMC Surgery Jul 2023It is generally expected that lumbar microdiscectomy affects radicular leg pain, but not so much local back pain. The primary objective was to evaluate if the...
PURPOSE
It is generally expected that lumbar microdiscectomy affects radicular leg pain, but not so much local back pain. The primary objective was to evaluate if the trajectories of changes in pain severity follow similar patterns for back and radicular leg pain after lumbar microdiscectomy. The secondary objective was to investigate the associations between some preoperative parameters and the patterns of these trajectories.
METHODS
Register-based retrospective study of 353 patients undergoing microdiscectomy in the lumbar spine. Linear mixed modelling was applied.
RESULTS
The average age of the participants was 46 years and 44% were women. The developmental trajectories were similar for both back and leg pain. Pain level decrease during the first year after the surgery, slightly worsening later. No statistically significant interactions were detected of preoperative pain duration or severity, sex or age on the shapes of the trajectories. For every analyzed grouping factor, the 95% confidence intervals overlapped at every postoperative time point with one exception - worse preoperative back pain was statistically significantly associated with worse pain at three months and at the end of the two-year follow-up.
CONCLUSION
After microsurgical discectomy, developmental curves for both back and radicular leg pain demonstrated similar patterns. Pain intensity decreased during the first year after the surgery. and slightly increased after that remaining, however, below the preoperative level. Age, sex, preoperative pain duration or preoperative intensity of leg pain were not associated with significant differences in the trajectories of pain severity after the surgery. In this study, severe preoperative back pain was the only factor, which was significantly associated with worse postoperative trajectory of pain intensity.
Topics: Humans; Female; Middle Aged; Male; Retrospective Studies; Diskectomy; Back Pain; Lumbosacral Region; Lumbar Vertebrae; Intervertebral Disc Displacement; Treatment Outcome
PubMed: 37496020
DOI: 10.1186/s12893-023-02114-3 -
Journal of Orthopaedic Surgery and... Jun 2022To explore the influence of irrigating fluid at different temperatures on patients' body temperature and local inflammatory mediators during spinal endoscopy. (Randomized Controlled Trial)
Randomized Controlled Trial
PURPOSE
To explore the influence of irrigating fluid at different temperatures on patients' body temperature and local inflammatory mediators during spinal endoscopy.
METHODS
110 cases of intervertebral foramen surgery in our hospital from January 2019 to October 2021 were randomly divided into control group and observation group. Operations of both groups were performed by the same experienced chief physician. The observation group was irrigated with 37 °C constant temperature saline, while the control group was irrigated at room temperature. The effect was evaluated by monitoring the intraoperative temperature, postoperative VAS score and the levels of inflammatory factors, such as TNF-α, IL-1, IL-6 and IL-10 in drainage fluid.
RESULTS
After 30 min of operation, overall temperature of the control group dropped significantly, and 50 cases (90.9%) had hypothermia, P < 0.05. There was no significant difference in preoperative VAS score between the two groups P > 0.05. The VAS score of observation group was significantly lower than that of control group at 6 h and 1 month after operation, P < 0.05. At 0, 3 and 6 h after operation, the values of TNF-α, IL-1, IL-6 and IL-10 in the observation group were significantly lower than those in the control group (P < 0.05).
CONCLUSIONS
Isothermal flushing solution can reduce the incidence of hypothermia and effectively alleviate local inflammatory reaction.
Topics: Body Temperature; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Hypothermia; Interleukin-1; Interleukin-10; Interleukin-6; Intervertebral Disc Displacement; Lumbar Vertebrae; Temperature; Tumor Necrosis Factor-alpha
PubMed: 35765022
DOI: 10.1186/s13018-022-03226-x -
Journal of Orthopaedic Surgery and... Mar 2024Anterior cervical discectomy and fusion surgery (ACDF) is a common technique in treating degenerative cervical spondylosis. This study is to evaluate the changes of...
BACKGROUND
Anterior cervical discectomy and fusion surgery (ACDF) is a common technique in treating degenerative cervical spondylosis. This study is to evaluate the changes of cervical muscles after ACDF and analyze the correlation between related muscle changes and clinical efficacy.
METHODS
Sixty-five postoperative patients (single-level ACDF) with cervical spondylotic myelopathy from January 2013 to December 2022 were analyzed. The measured parameters include: the axial section of longus colli cross-sectional area (AxCSA), the volume of cervical longus, the ratio of long and short diameter line (RLS), the cervical extensor cross-sectional area (CESA), the vertebral body area (VBA), and the CESA/VBA. The visual analog scale (VAS), modified Japanese Orthopedic Association score (mJOA), and neck disability index (NDI) were evaluated. The changes in muscle morphology were analyzed, and the correlation analysis was conducted between morphological changes and function scores.
RESULTS
The postoperative AxCSA of surgical segment (3rd month, 12th month, and the last follow-up) was decreased compared to preoperative (141.62 ± 19.78), and the differences were significant (P < 0.05). The corresponding data reduced to (119.42 ± 20.08) mm, (117.59 ± 19.69) mm, and (117.41 ± 19.19) mm, respectively (P < 0.05). The RLS increased, and the volume of cervical longus decreased significantly after surgery (P < 0.05). Negative correlation was found between postoperative volume of cervical longus and VAS at the 3rd month (r = - 0.412), 12th month (r = - 0.272), and last follow-up (r = - 0.391) (P < 0.05). Negative correlation existed between postoperative volume of cervical longus and NDI at the 3rd month (r = - 0.552), 12th month (r = - 0.293), and last follow-up (r = - 0.459) (P < 0.05).
CONCLUSION
The volume of cervical longus decreased and its morphology changed after ACDF surgery. The mainly affected muscle was the cervical longus closing to the surgical segment. Negative correlation was found between the postoperative volume of cervical longus and function scores (VAS and NDI).
Topics: Humans; Spinal Fusion; Retrospective Studies; Diskectomy; Neck; Treatment Outcome; Cervical Vertebrae; Spondylosis; Muscles
PubMed: 38493285
DOI: 10.1186/s13018-024-04605-2 -
Pain Physician Jul 2020Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc...
BACKGROUND
Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
OBJECTIVES
We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
STUDY DESIGN
This study used a retrospective design.
SETTING
Research was conducted in a hospital and outpatient surgical center.
METHODS
This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data.
RESULTS
Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD.
LIMITATIONS
The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection.
CONCLUSIONS
In patients with spondylolisthesis who have a herniated lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011.
KEY WORDS
Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic lumbar discectomy, retrospondylolisthesis, slippage.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Retrospective Studies; Spondylolisthesis; Treatment Outcome; Young Adult
PubMed: 32709174
DOI: No ID Found -
Neurologia Medico-chirurgica Jul 2023This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation...
This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH).A retrospective study of patients with L4/5 LDH treated with interlaminar endoscopic lumbar discectomy (IELD, n = 19) or transforaminal endoscopic lumbar discectomy (TELD, n = 105) was conducted. Patient background, radiological findings, and operative data were collected. Oswestry Disability Index (ODI) and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 1 and 2 years postoperatively.Although ODI and EQ-5D scores 1 and 2 years postoperatively improved statistically in the IELD and TELD groups, there were no statistical differences between the groups. IELD was predominantly performed in patients who were taller and heavier. The mean operative times and the frequency of laminectomy for IELD and TELD were 67.2 and 44.6 min and 63.2 and 17.1%, respectively (P < 0.001). The radiological findings showed that the concave configuration of the L4 lamina, interlaminar space width, and foraminal width were statistically different between the groups. There were no complications in either of the groups. Reoperation was required for recurrence in two and five patients in the IELD and TELD groups (P = 0.29), respectively.Operative outcomes were identical between the two groups. Although the operative time was longer in the IELD group, both approaches were safely and effectively performed. Depending on the patient's physique and preoperative radiological findings, the more suitable approach for L4/5 LDH should be chosen.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Quality of Life; Diskectomy, Percutaneous; Treatment Outcome; Endoscopy; Diskectomy; Lumbar Vertebrae
PubMed: 37164700
DOI: 10.2176/jns-nmc.2022-0357 -
Computer Methods and Programs in... Nov 2022Hybrid surgery, incorporating cervical disc replacement and anterior cervical discectomy and fusion, has shown good clinical results in the treatment of multilevel...
BACKGROUND AND OBJECTIVE
Hybrid surgery, incorporating cervical disc replacement and anterior cervical discectomy and fusion, has shown good clinical results in the treatment of multilevel cervical spondylosis according to early follow-ups. This study investigated the surgical strategy of hybrid surgery for two-level cervical spondylosis by distinguishing the biomechanical characteristics with different incorporating modes.
METHOD
A finite element model of a healthy cervical spine including C2-T1 was developed, and hybrid surgery was simulated by replacing at one level with Prestige-LP and fusion at another level with the anterior plate in C3-C5 (Hybrid-S1: replaced at C3-C4, Hybrid-S2: replaced at C4-C5), and in C4-C6 (Hybrid-M1: replaced at C4-C5, Hybrid-M2: replaced at C5-C6) and in C5-C7 (Hybrid-U1: replaced at C5-C6, Hybrid-U2: replaced at C6-C7). The motion of C2 vertebrae in flexion, extension, axial rotation, and lateral bending was imposed on all hybrid models following the displacement control testing protocol.
RESULTS
The largest range of motion (ROM) in a healthy spine was observed at C5-C6, followed by C3-C4, C4-C5 and C6-C7. On average, the ROM at the replaced segment increased by 175.7%, 202.7%, 176.3%, 117.1%, 139.4%, and 236.0% in Hybrid-S1, Hybrid-S2, Hybrid-M1, Hybrid-M2, Hybrid-U1, and Hybrid-U2, respectively. The facet joint stress at the replaced segment increased by 186.9%, 124.4%, 111.1%, 60.3%, 62.7%, and 144.7%, and the adjacent intradiscal pressure (IDP) increased by 45.2%, 38.7%, 2.7%, 2.1%, 13.9%, and 20.1%.
CONCLUSIONS
Incorporating mode in hybrid surgery affects cervical biomechanics. Hybrid surgery with replacement at a segment with a greater ROM and fusion at a segment with a lower ROM can results in fewer changes in terms of overall cervical stiffness, ROM at the operative level, facet joint stress, and adjacent IDP. In hybrid surgery, it is better to implement disc replacement at a level with a greater ROM and fusion of another segment.
Topics: Humans; Biomechanical Phenomena; Cervical Vertebrae; Diskectomy; Range of Motion, Articular; Spondylosis
PubMed: 36288687
DOI: 10.1016/j.cmpb.2022.107193