scholarly journals Foraminoplasty at the Tip or Base of the Superior Articular Process for Lateral Recess Stenosis in Percutaneous Endoscopic Lumbar Discectomy: A Multicenter, Retrospective, Controlled Study with 2-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jun-Song Yang ◽  
Lei Chu ◽  
Chien-Min Chen ◽  
Xiang-Fu Wang ◽  
Pei-Gen Xie ◽  
...  

Objective. To compare the clinical efficacy and complications which obtained foraminoplasty at the tip or base of the superior articular process (SAP) for the patients with lateral recess stenosis treated by percutaneous endoscopic lumbar discectomy (PELD). Methods. Between January 2015 and January 2016, 156 patients of lumbar disc herniation accompanying with lateral recess stenosis were treated with PELD in five tertiary hospitals and fulfilled the 2-year follow-up. Among them, 78 patients obtained a foraminoplasty at the tip of SAP (group A), and foraminoplasty at the base of SAP was performed in the other 78 cases (group B). Clinical efficacy was evaluated using the visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and 36-item Short-Form Health Survey (SF-36) score. The intervals of follow-up were scheduled at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Results. Mean operative duration is shorter in group B (55 versus 61 min, P = 0.047). Only one case belonged to group A could not tolerate the neural irritation and required conversion to an open procedure. During the surgery, no dura tears, cauda equina syndrome, or infections were observed. 5 patients experienced transient dysesthesia located at the exiting nerve in group A, while no cases complained dysesthesia in group B. 2 cases who suffered temporary motor weakness all belonged to group A. A total of 5 cases obtained a revision surgery after recurrence in the follow-up, in which 3 patients belonged to group A. Compared to the preoperative data, significant improvements in VAS scores of low back pain and sciatica, ODI, and SF-36 PCS and MC were observed in the follow-up, respectively (P < 0.05, respectively). However, no statistical difference was observed at all time-points after surgery between these two groups (P > 0.05, respectively). Conclusions. For the patients of LDH accompanying with lateral recess stenosis, compared with the routine foraminoplasty at the tip of SAP, our modified foraminoplastic technique does not only change place of foraminoplasty to the base of SAP but also simplified puncture process in transforaminal PELD. Although there was no significant difference in symptom relief, the modified foraminoplasty showed the advantages in decreasing the incidence of postoperative neural dysfunction and reducing operation time.

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Quanyi Li ◽  
Yongchun Zhou

Abstract Purpose To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH). Methods The clinical data of 1100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions Although conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.


2020 ◽  
Author(s):  
Jianhui Li ◽  
Boyuan Ma ◽  
Mengyao Wang ◽  
Jianwei Li ◽  
Shuijing Tian ◽  
...  

Abstract Background: This research aims to discuss the clinical application value of the superior articular process osteotomy navigation (SapON) technique in percutaneous endoscopic lumbar discectomy.Methods: Patients who underwent intervertebral foraminal endoscopic surgery for degenerative disease of the lumbar spine were collected and divided into two groups from March 2016 to May 2018. Group I: 69 patients were treated by the SapON technique. Group II: 53 patients were treated by Transforaminal Endoscopic Spine Surgery (TESS) technique. Fluoroscopy times, the time of establishment working channel, endoscopic operations, and entire operations in two groups were recorded. Patients' clinical curative effect was evaluated by visual analog scale (VAS) scores, Oswestry disability index(ODI), and MacNab standard at different time points, including before surgeries, one day, three months after surgeries, and the last follow-up time.Results: Operations were all successful both in groups I and II. Fluoroscopy times, establishing the working tunnels time, endoscopic operations time, and entire operations time and other indexes between the two groups were statistically significant. Patients’ low back, legs pain VAS scores, and ODI one day, three months after surgeries, and at the last follow-up in both two groups were significantly lower than those before operations with a statistical difference. The excellent rate in groups I and II were 98.55% and 96.23%. Complications were not observed in group I, while in group II, only one patient suffered the injury of the right L5 nerve root, and recovered after three months’ conservative treatment.Conclusion: The application of SapON in percutaneous endoscopic lumbar discectomy (PELD) has its advantages to popularize in clinical work, including operating simply and orderly, high safety, fewer complications, lower radiation exposure, and good clinical effects


Author(s):  
Ashvini Dineshrao Pardhekar ◽  
Sadhana Misar(Wajpeyi) ◽  
Vinod Ade

Background: Sthoulya is Medovaha Strotodushtijanya vyadhi, which includes abnormal and excessive accumulation of Medodhatu in the body. This is caused by lack of physical and mental activity, daytime sleep, excessive intake of madhur (sweet), snigdha ahar (oily diet) results in  increase Kaphadosha and meda which results in Sthoulya (overweight) having symptoms of mild dysponea, thirst, drowsiness, excess sleep, appetite, offensive smell from the body, incapability to work and incapability to participate in sexual intercourse. Aim: Comparative clinical efficacy of Tryushanadi Guggul and Navaka Guggul in Sthoulya (overweight). Materials and methods: Total 60 patients of Sthoulya will enrolled and will divided into two groups (each group contains 30). Patients in group A (experimental group) will be given 1 gram Tryushanadi Guggul two times a day after meal with honey and in group B (control group)1 gram Navaka Guggul will administered two times a day after meal with honey for 30 days. Dietary changes and walking (30 minutes) will be advised to patients of both groups. Follow up will be taken on 15th day and 30th day. Assessment of subjective parameters like kshudrashwasa (exertional dyspnoea), swedadhikya (perspiration), atikshudha (increased appetite), nidradhikya (increased sleep) and objective parameters like body weight, B.M.I., mid arm circumference, waist-hip ratio and lipid profile will be done before and after treatment. Results: Subjective and objectives outcomes will be assessed by statistical analysis. Conclusion: It will be drawn from the result obtained.


2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Shengxiang Ao ◽  
Junlong Wu ◽  
Yu Tang ◽  
Chao Zhang ◽  
Jie Li ◽  
...  

Objective. There is a steep learning curve with traditional percutaneous endoscopic lumbar discectomy (PELD). The aim of this study is to assess the safety and efficacy of PELD assisted by O-arm-based navigation for treating lumbar disc herniation (LDH).Methods. From September of 2017 to January of 2018, 118 patients with symptomatic LDH were enrolled in the prospective cohort study. The patients undergoing PELD with O-arm-based navigation technique were defined as group A (58 cases), and those undergoing traditional X-ray fluoroscopy method were defined as group B (60 cases). We recorded the operation time, cannula placement time, radiation exposure time, visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab criteria score of the 2 groups.Results. The average operation time (95.21 ± 19.05 mins) and the cannula placement time (36.38 ± 14.67 mins) in group A were significantly reduced compared with group B (operation time, 113.83 ± 22.01 mins, P<0.001; cannula placement time, 52.63 ± 17.94 mins, P<0.001). The learning curve of PELD in group A was steeper than that in group B and was lower in the relatively flat region of the end. There were significant differences of the clinical parameters at different time points (VAS of low back, P < 0.001; VAS of leg, P < 0.001; and ODI, P < 0.001). The VAS scores for low back pain and leg pain improved significantly in both groups after surgery and gradually improved as time went by. No serious complication was observed in any patients in either group.Conclusion. The study indicated that PELD assisted by O-arm navigation is safe, accurate, and efficient for the treatment of lumbar intervertebral disc herniation. It reshaped the learning curve of PELD, reduced the difficulty of surgery, and minimized radiation exposure to surgeons. This study was registered at Chinese Clinical Trail Registry (Registration Number:ChiCTR1800019586).


2021 ◽  
Author(s):  
Xiaoli Zhang ◽  
Wenping Zhao ◽  
Cong Sun ◽  
Zhihua Huang ◽  
Lifang Zhan ◽  
...  

Abstract BackgroundLocal anesthesia has been recommended for percutaneous endoscopic lumbar discectomy (PELD) in recent years; however, the efficacy, including oxidative stress, inflammatory reactions and ventilation effects, when intravenous dexmedetomidine (DEX) is administered during PELD has not been thoroughly described.MethodsSixty patients undergoing PELD were randomly allocated to either an intravenous DEX sedation group (Group A) or a normal saline group (Group B). Respiratory data, including minute ventilation (MV), tidal volume (TV), and respiratory rate (RR), were recorded using a respiratory volume monitor (RVM), and pulse oxygen saturation (SpO2) was measured by pulse oximetry. The visual analog score (VAS) and the plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and glutathione peroxidase (GSH-PX) were also recorded to evaluate oxidative stress and inflammatory reactions.ResultsThere were no significant differences in RR, MV, TV and SpO2 between the two groups at any time point (p>0.05). Group B exhibited lower serum levels of GSH-PX (p<0.0001) and higher serum levels of MDA (p<0.0001) than Group A at the end of surgery. Twenty-four hours after surgery, Group B exhibited higher serum levels of IL-6 (p=0.0033), TNF-α(p=0.0002), and MDA (p<0.0001) and lower serum levels of GSH-PX (p<0.0001) than Group A. In addition, Group B exhibited lower VAS (p<0.0001) than Group A.ConclusionsDEX administration using an RVM not only provides convenient analgesia and ventilation but also alleviates oxidative stress and inflammatory reactions in patients undergoing PELD .Trial registration ChiCTR2100044715(http://www.chictr.org.cn/index.aspx)


2020 ◽  
pp. 155335062097117
Author(s):  
Adolfo Renzi ◽  
Giandomenico Di Sarno ◽  
Francesco d’Aniello ◽  
Antonio Brillantino ◽  
Gianluca Minieri ◽  
...  

Background. Anti-reflux surgery is an effective treatment for gastroesophageal reflux disease (GERD). Nevertheless, surgery is still indicated with great caution in relation to the risk of complications, and in particular to postoperative dysphagia (PD). Objective. To compare the clinical outcomes, with particular focus on the incidence and severity of PD, of laparoscopic Nissen–Rossetti fundoplication (NRF) and floppy Nissen fundoplication (FNF) with complete fundus mobilization, in the surgical treatment of GERD. Methods. Ninety patients with GERD were enrolled. Forty-four patients (21[47.7%] men, 23[52.2%] women; mean age 42.4 ± 14.3 years) underwent NRF (Group A), and 46 patients (23[50%] men, 23[50%] women; mean age 43.3 ± 15.4 years) received laparoscopic FNF with complete fundus mobilization (Group B). Clinical assessment was performed using a structured questionnaire and SF-36 quality of life (QoL) score. PD was assessed using a validated classification, and an overall outcome was also determined by asking the patient to score it. Results. At 24-month follow-up, 38 (88.3%) patients in Group A vs 39 (86.6%) in Group B reported to be completely satisfied with reflux relief and free of protonic pump inhibitors (PPIs), while 3 (6.9%) in Group A vs 2(4.4%) in Group B reported occasional PPI intake and 2(4.6%) in Group A vs 4(8.8%) in Group B needed regular PPI use. Persistent PD was observed in 8(18.6%) patients in Group A and in 2(4.4%) in Group B ( P = .03). No significant differences were found in the QoL score and in the overall outcome perceived by the patients. Conclusion. FNF, with complete fundus mobilization, appears to be associated with a lower rate of postoperative persistent dysphagia.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Haimiti Abudouaini ◽  
Chengyi Huang ◽  
Hao Liu ◽  
Ying Hong ◽  
Beiyu Wang ◽  
...  

Abstract Background The effects of postoperative intervertebral height (IH) changes on the clinical and radiological outcomes after anterior cervical decompression and fusion (ACDF) surgery using a zero-profile device remain unclear. Methods We retrospectively reviewed patients who had undergone ACDF using a zero-profile device from March 2012 to February 2016 at our institution. Based on the postoperative IH variation, the patients were divided into group A with postoperative IH 0 to 2 mm, group B with postoperative IH 2 to 4 mm, and group C with postoperative IH greater than 4 mm. Clinical efficacy was evaluated using JOA, VAS, and NDI scores in the groups. Imaging parameters including the IH, cervical lordosis, fusion rate, intervertebral foramen (IVF) diameter and complications such as subsidence, dysphagia, and ASD were also compared across the three groups. Results The average IH increased significantly from 6.72 mm preoperatively to 10.46 mm 1 week after surgery, and then gradually decreased to 7.48 mm at the final follow-up. The fusion rate was 61.90% in group A, 63.23% in group B, 53.57% in group C at 3 months, 73.81% in group A, 79.41% in group B, 67.86% in group C at 6 months, 90.48% in group A, 95.59% in group B, 92.86% in group C 1 year after surgery, and at the last follow-up, the fusion rate of three groups was all 100%. The IVF diameter was 6.52 ± 1.80 mm in group A, 9.55 ± 2.36 mm in group B, and 9.34 ± 1.62 mm in group C. ASD at the superior and inferior levels affected 11.90 and 16.67% patients in group A, 5.88 and 7.38% in group B, and 14.28 and 10.71% in group C. Regarding the 3 groups, the subsidence rates were 7.14, 4.41, and 14.29%, respectively. Conclusions No clear correlation was found between IH changes and clinical efficacy within a year of surgery. However, the IH may affect various complications after ACDF. If postoperative IH changes are maintained at 2 to 4 mm after a year, a satisfactory imaging parameters and relatively low complications may be achieved after ACDF surgery using a zero-profile device.


2022 ◽  
Vol 23 (1) ◽  
Author(s):  
Peng Tao Wang ◽  
Jia Nan Zhang ◽  
Tuan Jiang Liu ◽  
Jun Song Yang ◽  
Ding Jun Hao

Abstract Background Pedicle screw invasion of the proximal articular process will cause local articular process degeneration and acceleration, which is an important factor affecting adjacent segment degeneration. Although lumbar spondylolisthesis is a risk factor for screw invasion of the proximal joint, there is no clear conclusion regarding the two different types of spondylolisthesis. Therefore, the purpose of this study was to explore the influence of pedicle screw placement on proximal facet invasion in the treatment of degenerative spondylolisthesis and isthmic spondylolisthesis. Methods In total, 468 cases of lumbar spondylolisthesis treated by decompression and fusion in our hospital from January 2017 to January 2020 were included in this retrospective study. Among them, 238 cases were degenerative spondylolisthesis (group A), and 230 cases were isthmic spondylolisthesis (group B). Sex, age, body mass index, bone mineral density, preoperative visual analog scale (VAS) and Oswestry Disability Index (ODI) scores, postoperative VAS and ODI scores at 1 month and 3 months, and angle of the proximal facet joint at the last follow-up were recorded and compared between the two groups. The degree of pedicle screw invasion of the proximal facet joint was graded and compared by the SEO grading method. Results There were no significant differences in sex, age, body mass index, bone mineral density, preoperative VAS and ODI scores, or proximal facet joint angle between the two groups (P > 0.05). There was no significant difference in VAS and ODI scores between the two groups at 1 month and 3 months after the operation (P > 0.05). The VAS score of group A at the last follow-up was 1 (1,2). The VAS score of group B at the last follow-up was 3 (1,3). The ODI score of group A at the last follow-up was 6(4,26). The ODI score of group B at the last follow-up was 15(8,36). The VAS and ODI scores of the two groups at the last follow-up were significantly different (P < 0.05). According to the SEO grading method, the invasion of the proximal articular process by pedicle screw placement in group A involved 320 cases in grade 0, 128 cases in grade I and 28 cases in grade II. In group B, there were 116 cases in grade 0, 248 cases in grade I and 96 cases in grade II, with a significant difference (P < 0.01). Conclusion In summary, a certain number of cases involving screws invading the proximal facet joint occurred in the two different types of lumbar spondylolisthesis, but the number in the isthmic spondylolisthesis group was significantly higher than that in the degenerative spondylolisthesis group, which caused more trauma to the proximal facet joint and significantly affected the patient prognosis.


2020 ◽  
Vol 11 (2) ◽  
pp. 261-264
Author(s):  
Urvee N Solanki ◽  
Darshan K Parmar

Introduction: Amalpitta is most common problem nowadays. Guduchyadi yoga kwatha was indicated in classics in the management of Amlapitta. Kwatha is very effective but it is unpleasant to some patients. So the kwatha was converted into preferable dosage form as requirement of present era. Material and Method: A Clinical trial was carried out on 60 Patients of Amlapitta aged 20 to 60 years with complaints of Aruchi, Avipaka, Tiktodgar, Amlodgar, Urodaha, Kanthadaha etc., who were registered from OPD of Government Ayurved Hospital, Vadodara. They were equally divided into two groups  i.e. Group A- Guduchyadi Syrup given in 20ml BD dose and Group B- Guduchyadi Ghanavati given at 500mg2 BD ). Each group was treated for 28 days administered empty stomach. The clinical assessment was carried out on the 28th  day and  2 weeks after the 28 days of treatment (after follow up period) for the  objective & subjective parameters and it was seen that both the dosage form Guduchyadi Syrup and Guduchyadi Ghanavati were very effective and cured or markedly relieved the symptoms of Amlapitta. Results: The study shows the effect of Guduchyadi Syrup and Guduchyadi Ghanavati, which led to cure in 16 patients (53.33%) and 22(73.33%) patients respectively, and markedly improvement in 12(40%) and 8(26.67%) patients affected with Amlapitta disease respectively. Conclusion: Both trial dosage forms of Guduchyadi Yoga, (Group A- Syrup & Group B- Ghanavati )  relieved the symptoms of Amlapitta and both the formulation have comparatively similar efficacy in the management of Amlapitta.


2020 ◽  
Author(s):  
Quanyi Li ◽  
yongchun zhou

Abstract Purpose: To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH). Methods: The clinical data of 1,100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded. Results: The follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions: Although conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.


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