scholarly journals Feasibility of Percutaneous Lumbar Discectomy Combined with Percutaneous Cementoplasty for Symptomatic Lumbar Disc Herniation with Modic Type I Endplate Changes

2017 ◽  
Vol 4 (20;4) ◽  
pp. E481-E488
Author(s):  
Ying Sheng Cheng
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Type I ◽  
Analog Scale ◽  
Percutaneous Cementoplasty ◽  
Endplate Changes ◽  
Modic Type ◽  
One Year

Background: Treatment of symptomatic lumbar disc herniation with Modic type I endplate changes is complex and challenging, requiring systemic and local therapies which include conservative therapy, epidural infiltrations, percutaneous therapeutic techniques, and surgical options. The clinical management of symptomatic lumbar disc herniation involving Modic type I endplate changes is uniquely challenging because it requires alleviating pain caused by both the herniated disc and the endplate osteochondritis. Through different approaches, percutaneous lumbar discectomy (PLD) and percutaneous cementoplasty (PCP) have been introduced into clinical practice as alternatives to traditional surgical and radiotherapy treatments of symptomatic lumbar disc herniation and other spine diseases. Objective: To evaluate the feasibility of PLD and PCP for symptomatic lumbar disc herniation with Modic type I endplate changes. Study Design: PLD and PCP in 7 patients with symptomatic lumbar disc herniation with Modic type I endplate changes and its clinical effects were retrospectively evaluated. Setting: This study was conducted by an interventional therapy group at a medical center in a major Chinese city. Methods: Seven consecutive patients (2 men, 5 women; median age, 74.14 ± 5.34 years; age range, 68 – 82 years) who underwent percutaneous lumbar discectomy and cementoplasty for the treatment of symptomatic lumbar disc herniation with Modic type I changes between May 2013 and August 2015 were retrospectively analyzed. The MacNab Criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI) for pain were assessed before and one week, 6 months, and one year after the procedure. Furthermore, the procedure duration, hospital stay length, and complications were assessed. Results: The VAS of the back and leg decreased from 6.14 ± 0.69 (range, 5 – 7) and 7.29 ± 0.76 (range, 6 – 8) preoperatively to 2.29 ± 1.38 (range, 1 – 5) and 2.71 ± 0.60 (range, 1 – 6) one week, 1.86 ± 0.69 (range, 1 – 3) and 2.00 ± 0.58 (range, 1 – 3) 6 months, and 1.71 ± 0.76 (range, 1 – 3) and 1.85 ± 0.69 (range, 1 – 3) one year postoperatively. The ODI dropped from 76.86 ± 7.45 (range, 70 – 82) preoperatively to 26.29 ± 19.47 (range, 16 – 70) one week, 19.14 ± 2.79 (range, 16 – 24) 6 months, and 18.57 ± 2.99 (range, 16 – 24) one year postoperatively. The mean procedure duration was 55.71 ± 6.07 minutes (range, 50 – 65 minutes). The average length of hospital stay was 7.57 ± 1.27 days (range, 6 – 10 days). No obvious complications were noted. Limitations: This was a retrospective study with a relatively small sample size. Conclusion: PLD plus PCP is a feasible technique for symptomatic lumbar disc herniation with Modic type I endplate changes. Key words: Percutaneous lumbar discectomy, percutaneous cementoplasty, lumbar disc herniation, endplate osteochondritis, Modic type I, feasibility, visual analog scale, Oswestry disability index

scholarly journals Feasibility and Efficacy of Percutaneous Lateral Lumbar Discectomy in the Treatment of Patients with Lumbar Disc Herniation: A Preliminary Experience

2015 ◽  
Vol 2015 ◽  
pp. 1-6
Author(s):  
Wenjin Jiang ◽  
Bolin Sun ◽  
Qirui Sheng ◽  
Xuepeng Song ◽  
Yanbo Zheng ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Japanese Orthopaedic Association ◽  
Japanese Orthopaedic Association Score ◽  
Lumbar Discectomy ◽  
Analog Scale ◽  
Association Score ◽  
Lumber Disc Herniation

Objective. This study was aimed at evaluating the effectiveness and safety of percutaneous lateral lumbar discectomy (PLLD) in treating patients with lumber disc herniation.Methods. A total of 183 patients with lumbar disc herniation were recruited to receive PLLD surgery from April 2006 to October 2011. All the adverse effects were recorded during the follow-up at 1, 3, 6, and 12 months after PLLD. The clinical outcomes were determined by visual analog scale and Japanese Orthopaedic Association score.Results. The surgery was performed successfully in all patients (102 males and 81 females aged from 21 to 66 years) with a mean 16.6-month follow-up (range from 26 to 65 months). No postoperative complications, including intestinal and vascular complications, nerve injuries, and postoperative infections, were associated with PLLD. At one month after surgery, visual analog scale (3.12±1.44versus6.76±2.31,P<0.05) was significantly lower than the baseline and was sustained until 24 months after surgery (3.25±1.78versus6.76±2.31,P<0.05). Besides that, Japanese Orthopaedic Association score (25.25±3.21versus11.78±2.38,P<0.05) was increased when compared to the baseline.Conclusions. PLLD was a promising, mini-invasive, and effective treatment for lumber disc herniation.

scholarly journals Full-Endoscopic Lumbar Discectomy for Two Contiguous Level Adolescent Lumbar Disc Herniation

2020 ◽  
Author(s):  
lu mao ◽  
Bin Zhu ◽  
Xiaotao Wu ◽  
Feng Wang ◽  
Cong Zhang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Visual Analog Scale ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Analog Scale ◽  
One Stage ◽  
Interlaminar Approach ◽  
Endoscopic Lumbar Discectomy

Abstract Background: Symptomatic lumbar disc herniation is rarely seen among adolescents. Adolescent lumbar disc herniation (ALDH) accounts for 0.5% to 6.8% of all those treated. Evidently, to our knowledge, no studies have emphasized the operative technique to treat two contiguous level adolescent lumbar disc herniation simultaneously. In this study, we aim to investigate the feasibility and advantages of one-stage full-endoscopic lumbar discectomy（FELD）for two contiguous level ALDH. This is the first paper, to my knowledge, dealing with two contiguous level ALDH simultaneously with one-stage full-endoscopic lumbar discectomy.Methods: Between January 2014 and December 2019, patients received FELD surgery for lumbar disc herniation (LDH) in 2 main minimally invasive spine center of China were selected for screening of this study. Data of 5877 cases were retrospectively analyzed (2780 cases and 3097 cases, respectively). The inclusion criteria were patient under 21-year old, two contiguous level symptomatic lumbar disc herniation received one-stage 2 level PELD surgery. Visual analog scale (VAS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results.Results: 11 patients were enrolled in this study (0.19%,11/5877), 8 patients were male and 3 were female. 9 patients with LDH in the same side underwent single-incision 2 level FELD surgery via transforaminal approach. 2 patients with LDH in different side underwent FELD surgery via combined transforaminal and interlaminar approach. There were no immediate perioperative complications. The visual analog scale (VAS) decreased significantly in both early and late follow-up evaluations and these score demonstrated significant improvement in late follow-up (P <0.01). For the modified MacNab criteria, the final outcome results were excellent in 9 patients (81.8%), good in 1 patients (0.9%), fair in1 patients (0.9%), and the overall success rate was 90.9%.Conclusion: One-stage full-endoscopic lumbar discectomy for 2 level symptomatic ALDH is an effective and less invasive method, which can be considered as an alternative good technique for selected adolescent patients.

scholarly journals A Pilot Study of Full-Endoscopic Annulus Fibrosus Suture Following Lumbar Discectomy: Technique Notes and One-Year Follow-Up

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E497-E505
Author(s):  
Zhen-zhou Li
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Annulus Fibrosus ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Group I ◽  
Interlaminar Approach ◽  
One Year ◽  
Endoscopic Lumbar Discectomy

Background: An annulus fissure or defect will inevitably be left on the posterior annulus fibrosus after almost all kinds of lumbar discectomy, which may lead to unsatisfying postoperative pain relief and recurrence of the disc herniation. Objective: The objective of this research is to introduce the technique of full-endoscopic annulus fibrosus suture following lumbar discectomy through the transforaminal or interlaminar approach, and to analyze the clinical outcome of full-endoscopic lumbar discectomy and annulus fibrosus suture. Study Design: This study used a prospective cohort design. Setting: The research was conducted in a hospital and outpatient surgery center. Methods: A total of 50 patients with noncontained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture were treated in our department between January 2018 and November 2018. Full-endoscopic single-stitch suture via the transforaminal approach (Group T) or double-stitch suture via the interlaminar approach (Group I) was selected according to the level of lesion. Lumbar magnetic resonance imaging (MRI) was reexamined on the second day and 3 months after operation to evaluate the completeness of the discectomy and the adequacy of nerve decompression. Patients were followed up on the second day, 3 months, 6 months, and one year after operation to evaluate the relief of low back pain and leg pain, using a visual analog scale (VAS, 100-point scale). At 3 months, 6 months, and one year after operation, the patients were followed up for recovery of lumbar spine function, using the Oswestry Disability Index (ODI). At the one-year follow-up, the MacNab score was used to evaluate the clinical outcome, and the recovery of nerve root function (sensation, muscle strength, and reflex) was recorded. Results: All operations were successfully completed, including 27 cases in Group T and 23 cases in Group I. There were no surgical complications and no recurrence of lumbar disc herniation. Lumbar MRI reexaminations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. Postoperative low back pain and leg pain were significantly relieved, and the ODI score was significantly improved (P < .01) in both groups. At the one-year follow-up, the excellent and good rates as measured by the MacNab score were 92.6% in Group T and 91.3% in Group I with no significant difference between the 2 groups (P > .05). The impaired sensation and muscle strength in the low extremities of evolved nerve root of the 2 groups of patients recovered significantly at the oneyear follow-up (P < .01), but the tendon reflex did not recover significantly (P > .05). Limitations: This is an observational cohort study with relatively small sample sizes and short-term follow-up. Conclusions: Full-endoscopic lumbar discectomy and annulus fibrosus suture through either the transforaminal or interlaminar approach are safe and effective minimally invasive spinal surgery techniques that can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy. Keywords: Annulus fibrosus suture; full-endoscope; lumbar disc herniation; lumbar discectomy; minimally invasive spinal surgery

scholarly journals Full-endoscopic lumbar discectomy for two contiguous level adolescent lumbar disc herniation

2020 ◽  
Author(s):  
lu mao ◽  
Bin Zhu ◽  
Tao xiao Wu ◽  
Feng Wang ◽  
Cong Zhang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Visual Analog Scale ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Analog Scale ◽  
One Stage ◽  
Interlaminar Approach ◽  
Endoscopic Lumbar Discectomy

Abstract Background Symptomatic lumbar disc herniation is rarely seen among adolescents. Adolescent lumbar disc herniation (ALDH) accounts for 0.5–6.8% of all those treated. Evidently, to our knowledge, no studies have emphasized the operative technique to treat two contiguous level adolescent lumbar disc herniation simultaneously. In this study, we aim to investigate the feasibility and advantages of one-stage full-endoscopic lumbar discectomy(FELD)for two contiguous level ALDH. This is the first paper, to my knowledge, dealing with two contiguous level ALDH simultaneously with one-stage full-endoscopic lumbar discectomy. Methods Between January 2014 and December 2019, patients received FELD surgery for lumbar disc herniation (LDH) in 2 main minimally invasive spine center of China were selected for screening of this study. Data of 5877 cases were retrospectively analyzed (2780 cases and 3097 cases, respectively). The inclusion criteria were patient under 21-year old, two contiguous level symptomatic lumbar disc herniation received one-stage 2 level PELD surgery. Visual analog scale (VAS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Results 11 patients were enrolled in this study (0.19%,11/5877), 8 patients were male and 3 were female. 9 patients with LDH in the same side underwent single-incision 2 level FELD surgery via transforaminal approach. 2 patients with LDH in different side underwent FELD surgery via combined transforaminal and interlaminar approach. There were no immediate perioperative complications. The visual analog scale (VAS) decreased significantly in both early and late follow-up evaluations and these score demonstrated significant improvement in late follow-up (P < 0.01). For the modified MacNab criteria, the final outcome results were excellent in 9 patients (81.8%), good in 1 patients (0.9%), fair in1 patients (0.9%), and the overall success rate was 90.9%. Conclusion One-stage full-endoscopic lumbar discectomy for 2 level symptomatic ALDH is an effective and less invasive method, which can be considered as an alternative good technique for selected adolescent patients.

EFFICACY OF ANTIBIOTICS PROPHYLAXIS IN PATIENTS WITH LUMBAR DISC HERNIATION UNDERGOING LUMBAR DISCETOMY

2018 ◽  
Vol 8 (5) ◽  
pp. 14-19
Author(s):  
Tri Truong Van ◽  
Tri Tran Duc Duy ◽  
Khai Vo Le Quang
Keyword(s):  
Surgical Site Infection ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
University Hospital ◽  
Site Infection ◽  
Surgical Wound ◽  
A Prospective Study ◽  
Length Of Hospitalization

Introduction: Surgical wound infection in developing coutries is about 3%. Antibiotics prophylaxis may help to reduce the surgical site infection. The objective of this study was to evaluate the efficacy of antibiotics prophylaxis in patients with lumbar disc herniation who were treated with lumbar discectomy at Hue University hospital. Materials and Methods: A prospective study was conducted at Hue University hospital from March 2015 to May 2018 on 54 patients with lumbar disc herniation who were used antibiotics prophylaxis when undergoing discectomy. Results: The infection rate in our study was 0%. Antibiotics prophylaxis reduced the length of hospitalization as well as the medical cost. Conclusion: Antibiotics prophylaxis was effective in preventing surgical site infection despite the fact that the condition of operating rooms did not meet the standard rules. Key words: prophylaxis antibiotics, lumbar disc herniation

scholarly journals A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Manyoung Kim ◽  
Sol Lee ◽  
Hyeun-Sung Kim ◽  
Sangyoon Park ◽  
Sang-Yeup Shim ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Lumbar Microdiscectomy ◽  
Surgical Methods ◽  
Endoscopic Lumbar Discectomy

Background. Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points. Objectives. The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population. Methods. In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library. Results. Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13). Limitations. All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well. Conclusion. While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods.

scholarly journals Analysis of the efficacy of ozone therapy on different types of lumbar disc herniation: a new guidance is coming? [abstract]

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Kenan Hao ◽  
Huan Liu ◽  
Yang Yang ◽  
Qingle Zeng ◽  
Xiaofeng He
Keyword(s):  
Nucleus Pulposus ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Ozone Treatment ◽  
Type I ◽  
Type Ii ◽  
Ring Type ◽  
Type Iv ◽  
Fibre Ring

PURPOSE: To investigate the sub-types of lumbar disc herniation, compare efficacies of ozone treatment in various types of lumbar disc herniation and analyze the mechanisms. MATERIAL AND METHODS: A total of 250 patients (159 males, 91 females; age range: 14 - 85 years) diagnosed of lumbar disc herniation from January 2009 to Jun 2014 in Nanfang Hospital were enrolled. Disc Lesions, classified by Magnetic Resonance examinations and images when injecting ozone under Digital Subtraction Angiography, were divided into four types: type I: Non-prominent nucleus pulposus with ruptured fibre ring; type II: Prominent nucleus pulposus with ruptured fibre ring; type III: Non-prominent nucleus pulposus with Non-ruptured fibre ring; type IV: Prominent nucleus pulposus with Non-ruptured fibre ring. All patients underwent intradiscal and paravertebral injection of oxygen-ozone. Visual Analogue Scale (VAS) weighted score was administered for the measurement of low back pain before treatment, and the evaluation of efficacy respectively at 1 week, 1 month, 6 month and 12 month follow-up period. RESULTS: Most of the patients (about 4/5) showed better response to ozone treatment. Herniated disc shrinkage was obtained among type II and IV. The type II had the most reduction of average score while the type III had the least. The proportion of patients who had once experienced pain relief at the follow up interval, namely the curative efficacy, showed significant difference: type I occupied the most, type IV occupied the least. CONCLUSION: Ozone treatment is effective and safe for all types of lumbar disc herniation, but efficacy varies according the types, of which type I has the best results and type IV has the worst ones.

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