Objective To compare the clinical efficacy and safety of unilateral biportal endoscopy discectomy (UBED) versus percutaneous uniportal endoscopic interlaminar discectomy (PEID) for the treatment of single lumbar disc herniation (sLDH). Methods A retrospective analysis was conducted on 52 patients with sLDH who underwent UBED or PEID at the Affiliated Hospital of Southwest Medical University between January 2022 and June 2023. Surgical parameters, clinical outcomes, and imaging indicators were compared between the two groups. For normally distributed quantitative data, mean ± standard deviation was used for representation, while for non-normally distributed data, median (lower quartile, upper quartile) was used for representation. Results No significant difference was observed between the two groups in terms of gender, age, disease duration, affected segments, preoperative Visual Analogue Scale (VAS) scores for low back and leg pain, preoperative Oswestry Disability Index (ODI) scores, preoperative disc height ratio (DHR), or preoperative sagittal rotation angle (SRA) (P>0.05). All patients successfully underwent surgery. In the UBED group, one case of cerebrospinal fluid leakage and one case of pseudomeningocele syndrome occurred postoperatively. In the PEID group, two cases of pseudomeningocele syndrome occurred postoperatively, and one case of recurrence was observed 1.5 years after surgery. Both groups showed significant improvements in VAS scores for low back and leg pain and ODI scores postoperatively and during follow-up compared to preoperative values (P<0.05). Significant differences were found between the UBED and PEID groups in terms of operation time [(138.3±28.0) vs. (113.5±34.2) min], intraoperative blood loss [(58.6±24.4) vs. (45.7±20.3) mL], postoperative drainage volume [(48.7±16.9) vs. (30.0±13.4) mL], postoperative ambulation time [3.4 (3.0, 4.0) vs. 2.3 (2.0, 3.0) d], and VAS scores for low back pain on postoperative Day 1 (2.87±0.55 vs. 2.24±0.65) (P<0.05). No significant difference was observed in intraoperative fluoroscopy frequency, VAS scores for leg pain on postoperative Day 1, VAS scores for low back and leg pain 6 months and 1 year after operation, postoperative hospital stay, postoperative complication rates, ODI scores 1 year after operation, DHR 1 year after operation, SRA 1 year after operation, or MacNab evaluation 1 year after operation (P>0.05). Conclusions Both UBED and PEID are safe and effective treatments for sLDH, with similar complication rates and clinical outcomes. However, PEID demonstrates advantages in reducing soft tissue damage and accelerating perioperative recovery.
Objective To compare the therapeutic effect of conventional discectomy, posterior lumbar interbody fusion (PLIF), and transforaminal lumbar interbody fusion (TLIF) on the recurrent lumbar disc protrusion (RLDP). Methods From January 2000 to January 2008, 65 patients with RLDP underwent different surgical procedures, namely conventional discectomy (group A, 25 cases), PLIF (group B, 22 cases), and TLIF (group C, 18 cases). There were 44 males and 21 females aged 26-65 years old (average 41 years old). All the patients were single-level protrusion, including 33 cases at the L4, 5 level and 32 cases at the L5, S1 level. The primary procedure included laminectomy discectomy in 39 patients, unilateral hemilaminectomy discectomy in 15 patients, and bilateral laminectomy and total laminectomy discectomy in 11patients. The recurrent time to the primary operation was 13-110 months (average 64 months). The location of recurrent disc protrusion was at the ipsilateral side in 47 cases and the contralateral side in 18 cases. No significant differences among three groups were evident in terms of basel ine data (P gt; 0.05). Results The incision all healed by first intention. The incidence of perioperative compl ication in group A (24.0%) and group B (22.3%) was significantly higher than that of group C (5.6%) (P lt; 0.05), and there was no significant difference between group A and group B (P gt; 0.05). The operation time and bleed loss during operation of group B were obviously higher than that of group A and group C (P lt; 0.05), and there was no significant difference between group A and group C (P gt; 0.05). There were no significant differences among three groups in terms of the length of hospital ization (P gt; 0.05). Six-one patients were followed up for 12-36 months (average 20 months). At 1 week after operation, the satisfied rate of patients was 84.0% in group A, 81.8% in group B, and 88.9% in group C (P gt; 0.05). All the patients in group B and group C achieved fusion uneventfully. There were no significant differences among three groups in terms of visual analogue scale (VAS) and Oswestry disabil ity index (ODI) when compared the preoperative value with the final follow-up value (P gt; 0.05). There was significant difference within group A, B, and C in terms of VAS and ODI when compared the preoperative value with the final follow-up value (P lt; 0.05), but there were no significant differences among three groups in the improvement rate (P gt; 0.05). The intervertebral space grading method proposed by Roberts et al. was adopted to evaluate the intervertebral space height (ISH), the preoperative value was 2.04 ± 0.93 in group A, 2.18 ± 0.91 in group B, and 2.11 ± 0.90 in group C, andat the final follow-up, the value was 2.64 ± 0.58 in group A, 1.05 ± 0.59 in group B, and 1.06 ± 0.42 in group C. There were significant differences among three groups in the ISH when compared the properative value with the final follow-up value (P lt; 0.05). Conclusion All of the three surgical procedures are effective for RLDP, but conventional discectomy and PLIF have more compl ications than TLIF. Conventional discectomy may result in the further narrow of the intervertebral space and the occurrence of segment instabil ity, whereas TLIF is safer, more effective, and one of the ideal methods to treat RLDP.
Objective To evaluate the effectiveness and safety of different injection sites for collagenase chemonucleolysis for lumbar intervertebral disc protrusion (LIDP). Methods We searched for randomized controlled trials (RCTs) and quasi-RCTs in the following electronic databases: Pubmed (1966 to May 2006), EMBASE(1966 to May 2006), The Cochrane library (Issue 2, 2006), CRD(Center for Reviews and Dissemination),York University, CBM (1978 to May 2006 ), CNKI(1994-2006)and VIP(1989-2006). Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. Results Eight studies involving a total of 1035 participants met the inclusion criteria. Meta-analysis was not carried out because of apparent heterogeneity. Four studies made comparisons among intradisc, extradisc, and combined intra- and extra-disc injection. One study (62 participants) showed that intradisc injection was superior to extradisc injection (RR 3.71, 95% CI 1.19 to 11.58, Plt;0.05). Another study (240 participants) showed that intradisc injection was superior to combined intra- and extra-disc injection after 3 months and 6 months of follow-up (RR 0.88, 95% CI 0.80 to 0.98, Plt;0.05). The other two studies showed no significant difference among intradisc, extradisc, and combined intra- and extra-disc injection. Four studies (436 participants in total) showed that amongst three extradisc injections, both anterior epidural space injection and lateral epidural space injection were superior to posterior epidural space injection (Plt;0.05). Although one study indicated that anterior epidural space injection was superior to lateral epidural space injection (RR 1.24, 95% CI 1.03 to 1.51, Plt;0.05), no statistical significance was found between anterior epidural space injection and lateral epidural space injection in two other studies (Pgt;0.05). Conclusions There is insufficient evidence to identify which injection site for collagenase is the most effective for lumbar intervertebral disc protrusion. The included studies showed that both anterior and lateral epidural space injection were superior to posterior epidural space injection. However, these studies are too small and poor quality, and have different diagnostic criteria, follow-up time points, outcome measures and efficacy parameters. Thus, more high quality and large-scale RCTs are needed.
ObjectiveTo explore the clinical efficacy of percutaneous endoscopic interlaminar discectomy (PEID) and interlaminar fenestration discectomy in the treatment of lumbar (L) 5-Sacral (S) 1 lumbar disc herniation (LDH).MethodsLDH patients were retrospectively included from January 2016 to Januray 2018. And the patients were divided into the PEID group and the fenestration group according to their choice of different surgical methods. The operation time, intra-operative blood loss, and bed rest time in the two groups were recorded. The preoperative and postoperative [1 week, 1 month, 3 months, and last follow-up (>12 months)] Visual Analogue Score (VAS) of the lumbago and leg pain between the two groups were compared; the preoperative and postoperative [1 week, and last follow-up (>12 months)] Oswestry Disability Index (ODI) and also the postoperative [(>12 months)] therapeutic effect (modified MacNab) between the two groups were compared.ResultsA total of 66 patients were included, with 31 in the PEID group and 35 in the fenestration group. There was no significant difference in age, gender and course of disease between the two groups (P>0.05). There were leakage of cerebrospinal fluid and transient lumbago, leg pain and numbness, which were worse than those before operation in the PEID group (1 and 1 patient, respectively) and the fenestration group (2 and 3 patients, respectively). There were statistically significant differences between the PEID group and the fenestration group, in the operative time [(90.65±9.98) vs. (66.23±16.50) minutes], intra-operative blood loss [(51.77±18.64) vs. (184.29±78.38) mL], and bed time [(2.87±0.92) vs. (7.49±1.20) d] (t=−7.365, t’=−9.697, t=−17.374, P<0.001). There was no significant difference in the preoperative VAS score (lumbar-leg pain) and ODI index, and the ODI index at each postoperative time point, between the two groups (P>0.05). VAS score (lumbago) and VAS score (leg pain) in the PEID group at each postoperative time point were lower than those in the fenestration group (P<0.05); VAS scores (leg pain) at other time points were not statistically significant between the two groups (P > 0.05). VAS (lumbar-leg pain) score and ODI index at each postoperative time point were lower than those before the surgery. The was no statistically significant difference in the PEID group (90.32%) and fenestration group (85.71%) in the excellent rate (χ2=0.328, P=0.713).ConclusionsPEID has less surgical trauma, less bleeding, short bed rest, fast recovery, and better relief of postoperative lumbago symptoms. It is worthy of further promotion in clinical work.
目的 探讨老年人腰椎间盘突出合并侧隐窝狭窄症的临床特点及手术方式，总结和介绍小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术的优点和可行性。 方法 2006年7月－2011年1月对76例患者行后正中切口4.0～6.0 cm，在C臂X线机定位下，保留棘上、棘间韧带和棘突，骨膜下剥离骶棘肌，显露椎板、椎板间隙和关节突起，在椎板间隙间开骨窗，切除关节突内侧小部分后，环形切除突出的纤维环取出髓核，扩大成形侧隐窝，解除所有卡压脊神经根组织，彻底松解脊神经根。 结果 术后76例随访15～24个月，平均18个月，均按中华脊柱外科学会脊柱学组腰腿痛手术评定标准评定：优63例，良10例，一般及差3例，优良率达96.05%。手术前后Oswestry功能障碍指数评分与腰痛及腿痛视觉模拟评分法评分比较，差异有统计学意义（P＜0.05）。 结论 小切口单侧椎板开窗椎间盘摘除联合侧隐窝扩大术，是一种手术创伤小，能在直视下操作，避免手术失误，彻底去除神经根致压物，不仅能够扩大神经根管，而且可行侧隐窝的探查及松解，同时兼顾脊柱稳定结构基本不被破坏，疗效满意，尤其在老年人中值得推广。
目的:观察手法复位配合针刺治疗腰椎间盘突出症的疗效。方法:将239例确诊为腰椎间盘突出症的患者随机分为治疗组和对照组，其中治疗组120例，采用手法复位配合针刺治疗，对照组119例，采用针刺治疗。并分别观察两组患者症状评分变化和疗程。结果:治疗组总显效率85.83%，对照组72.27%（Plt;0.05）。治疗组痊愈率53.33%，对照组36.13%（Plt;0.05）。治疗组显效病例，达到显效时所需的治疗时间为12.60±3.39天，对照组为16.85±4.15天（Plt;0.05）。结论:手法复位配合针刺治疗腰椎间盘突出症优于针刺治疗。
ObjectiveTo observe the efficacy and safety of the posterior fusion dynamic system (Dynesys) on lumbar intervertebral disc. MethodsBetween April 2010 and April 2012, 30 patients diagnosed lumbar disc herniation in our department were included in the study. The Dynesys was performed on these patients. Follow-up lasted for 6 to 12 months. We used visual analogue scale (VAS) and Oswestry disability index (ODI) to evaluate the efficacy and safety of the system at the time points of the day before surgery, 1 week, 3 months and 6 months after surgery. Paired-samples t-test was used in the data analysis. ResultsThe VAS score 1 day before surgery was 7.9±0.9; 1 week after surgery, VAS was 2.1±0.8 (t=49.395, P<0.001); 3 months after surgery, VAS was 1.6±0.4 (t=88.304, P<0.001); 6 months after surgery, VAS was 1.4±0.3 (t=93.721, P<0.001). ODI 1 day before surgery was (74.0±6.0)%; 1 week after surgery, ODI was (19.6±2.5)% (t=82.006, P<0.001); 3 months after surgery, ODI was (16.3±1.2)% (t=88.344, P<0.001); 6 months after surgery, ODI was (14.5±1.8)% (t=90.113, P<0.001). All the patients were given X ray review 1 week, 3 months, and 6 months after surgery. No screw loosening or breakage was detected. ConclusionThe combination of Dynesys and decompression surgery has been proved to be effective and safe in the short term. Dynesys reserves the mobility of pathological lumbar, ensures the stability of the posterior spine and corrects lumbar instability.