scholarly journals Minimally invasive high-definition microscope assisted small channel treatment of lumbar disc herniation in children: a case report

2021 ◽  
Author(s):  
Hao Yuan ◽  
Nan Zhao ◽  
Jun Ao ◽  
Lv Sun ◽  
Chong Wang ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Muscle Strength ◽  
Minimally Invasive ◽  
Disc Herniation ◽  
Lower Limb ◽  
Lumbar Disc ◽  
High Definition ◽  
Small Channel ◽  
Left Lower Limb

Abstract Background: Despite lumbar disc herniation (LDH) is common in adults, it is extremely rare in children. The treatment of LDH in children is still a challenge for surgeons. This study aimed to explore the pathogenesis, clinical characteristics and treatment methods of LDH in children for communication and learning.Methods: In October 2017, a child with LDH who failed to receive conservative treatment underwent surgical treatment. The child underwent minimally invasive high-definition microscope-assisted nucleus pulposus resection and nerve root decompression. The soft tissues such as muscles and paravertebral ligaments were separated and removed under microscope, the nucleus pulposus of disc herniation was removed, and the left lumbar 5 nerve root was decompressed. During the short-term and long-term follow-up after operation, the assessment pain was significantly improved, the activity was not limited, and the muscle strength returned to normal.Results: The next day after operation, the child could wear ordinary waist circumference to get out of bed, and the left lower limb muscle strength returned to grade 4-5, and were discharged 5 days after operation. After 3 years of telephone follow-up, the patient complained that the pain was significantly relieved, the left lower limb movement was not limited, and the muscle strength returned to normal. Conclusions: In this case, the minimally invasive high-definition microscope assisted small channel treatment of LDH in children was successful, and the postoperative recovery was good. It can provide reference for LDH in children who need surgical treatment when conservative treatment was ineffective.

scholarly journals Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

2018 ◽  
Vol 21 (5) ◽  
pp. 449-455 ◽  
Author(s):  
Julio D. Montejo ◽  
Joaquin Q. Camara-Quintana ◽  
Daniel Duran ◽  
Jeannine M. Rockefeller ◽  
Sierra B. Conine ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Pediatric Patients ◽  
Lumbar Disc ◽  
Low Back ◽  
Duration Of Symptoms ◽  
Patient Reported ◽  
The Mean

OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

scholarly journals Outcome of Surgical Treatment for Lumber Disc Herniation Causing Painful Incomplete Foot-Drop

2020 ◽  
Vol 24 (3) ◽  
Author(s):  
MUSAWER KHAN ◽  
AKRAM ULLAH ◽  
ADNAN AHMED ◽  
MUMTAZ ALI ◽  
MANSOOR AHMAD
Keyword(s):  
Surgical Treatment ◽  
Pain Relief ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Foot Drop ◽  
Disc Disease ◽  
Lumbar Disc Disease ◽  
Number Of Patients

Objective:  To determine the outcome of surgical treatment for lumder disc herniation causing the painful incomplete foot drop. Material and Methods:  This retrospective observational study was conducted at the Department of Neurosurgery Lady Reading Hospital, Peshawar. Both Male and female patients with lumbar disc disease causing unilateral incomplete painful foot drop were included in our study. Patients with complete or painless foot drop, bilateral foot-drop, Multiple level disc prolapse, cauda equina syndrome or sciatic neuropathy due to injection injury were excluded. Patients were followed was post-operatively in terms of power in foot dorsiflexion, medical research council (MRC) grade and pain relief  on a Visual Analogue Scale (VAS) after 1 month and then after 6 months. Results: Total number of patients included were 43. Age was ranging from 18 years to 54 years and mean age was 33 years. Before surgery,  power of MRC grade 3 or less, but greater than 1 in dorsiflexion was noted in all patients. The pain was scaled using VAS. Post peratively, at 1 month follow up, the foot-drop improved to MRC grade 4 or 5 along with pain relief of ≥ 2 points on VAS in 81. 4% (n = 35) patients and at 6 month follow-up, the figure rose to 93% (n = 40). Conclusion:  Lumbar disc disease can cause a debilitating foot-drop and pain. Improving or restoring a neurology early surgical intervention has proven benefits.

scholarly journals Minimally-invasive procedure for pelvic leak points in women

2019 ◽  
Vol 8 (1) ◽  
Author(s):  
Roberto Delfrate ◽  
Massimo Bricchi ◽  
Claude Franceschi
Keyword(s):  
Surgical Treatment ◽  
Minimally Invasive ◽  
Lower Limb ◽  
Varicose Veins ◽  
Absorbable Suture ◽  
Pelvic Congestion Syndrome ◽  
Minimally Invasive Surgical ◽  
Hemodynamic Assessment ◽  
Pelvic Congestion

Pelvic leak points (PLP) may be responsible for vulvar, perineal and lower limb varicose veins, in women during and/or after pregnancy. The accurate anatomical and hemodynamic assessment of these points, the perineal (PP), inguinal (IP) and clitoral points (CP) and their surgical treatment under local anesthetics as defined by Claude Franceschi is a new therapeutic option. The aim of this study was to assess the reliability and durability of the PLP reflux ablation using a minimally-invasive surgical disconnection at the PLP level in women with varicose veins of the lower limbs fed by the PLP. In this open-label trial 273 pelvic leak points free of pelvic congestion syndrome, with at least a 12-month follow- up, were assessed. 273 PLP treated: PP (n=177), IP (n =91) and CP (n=5). Followup: Period =12 to 92 months (mean =30.51 months). Age from 29 to 77 years (mean=45). The only 3 patients over 70 years (71, 74, 77) showed a high-speed reflux from a I point that fed symptomatic varicose veins of the lower limb. Exclusion criteria: pelvic congestion syndrome, BMI>24, venous malformations, a post thrombotic varicose vein. Diagnosis was performed using echo duplex and PLPs selected for treatment when refluxing at Valsalva + Paraná + squeezing maneuvers. A surgical skin marking of the PLP had been performed using echo duplex before surgery. Surgery consisted of minimally invasive dissection and selective division and ligation with non-absorbable suture of the refluxing veins and fascias at the PP, IP and CP pelvic escape points, under local anesthesia in a single center. The follow-up consisted of an echo duplex ultrasound, searching for reflux at the PLP treated thanks to the Valsalva maneuver, within 2 weeks, after 6 and 12 months and then yearly. The main endpoint of the study was the immediate elimination of the reflux at the PLP treated. The second endpoint was the long-term durability of the reflux ablation at the PLP treated. 267 (97.8%) without PLP reflux redo. 6 (2.2%) PLP reflux recurrences (PP=4, IP=1, CP 1). 3 patients with PLP reflux recurrence undergo a redo surgery (1.1%) where PP=2 (0.7%) and IP=1 (0.3%). This study shows the feasibility and durability of reflux ablation at the PLP level thanks to a minimally-invasive surgical treatment of the PLP and it demonstrates that there is no need for pelvic varicose embolization in patients without clinical signs of pelvic congestion syndrome. The accurate ultrasound assessment of each specific pelvic leak as well as a special surgical technique (vein division, non-absorbable suture of veins and fascias) seems to be the key for satisfactory outcomes.

scholarly journals Lumbar Disc Herniation Might Spontaneously Regress, While Neuropathic Pain Might Start: Retrospective Clinical Study

2020 ◽  
Vol 8 (10) ◽  
pp. 2243-2247
Author(s):  
Yener Akyuva ◽  
Necati Kaplan ◽  
Boran Urfalı ◽  
Özkan Özger ◽  
Erdinç Civelek ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Surgical Treatment ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Spontaneous Regression ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Initial Examination ◽  
Retrospective Clinical Study

Lumbar disc herniation (LDH) is a common cause of low back pain and radicular pain. The aim of our study was to evaluate the regression of LDH in patients who are considered to require surgical treatment but prefer conservative treatment. Patients who presented between January 2018 and June 2020 and who did not accept the recommended surgical treatment following a diagnosis of LDH based on clinical and radiological findings were retrospectively reviewed. All 12 of the patients included in the study showed spontaneous regression of LDH during outpatient clinical follow-up. Our study included 12 patients (seven male and five female). The mean age was 46.5 (the youngest was 30 years old; the oldest was 70 years old). Regression was observed at the L2-L3 level in two patients (10%), at the L4-L5 level in four patients (40%), and at the L5-S1 level in six patients (50%). On the follow-up examination of all patients, the severity of their pain was evaluated with the Visual Analogue Scale, and all patients described a reduction in pain (min: 2, max: 8). Ten patients described radicular pain at the initial examination, eight patients received physical therapy and rehabilitation treatment before the follow-up examination, and nine patients described neuropathic pain at the follow-up examination. Spontaneous regression of LDH is rare. While conservative treatments provided partial improvement in the complaints of these patients, conservative treatments usually cannot prevent the development of neuropathic pain.

Minimally invasive lumbar microdiscectomy in pediatric patients: a series of 6 patients

2011 ◽  
Vol 7 (6) ◽  
pp. 616-619 ◽  
Author(s):  
Jonathan G. Thomas ◽  
Steven W. Hwang ◽  
William E. Whitehead ◽  
Daniel J. Curry ◽  
Thomas G. Luerssen ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Presenting Symptoms ◽  
Lumbar Microdiscectomy ◽  
Imaging Results ◽  
The Mean

Object Lumbar disc herniation is rare in the pediatric age group, but may still cause a significant amount of pain and disability. Whereas minimally invasive surgery (MIS) for lumbar disc herniation is routinely performed in adults, it has not yet been described in the pediatric population. The purpose of this study was to describe the surgical results of pediatric MIS-treated lumbar disc disease. Methods The authors retrospectively reviewed a series of 6 consecutive cases of lumbar microdiscectomy performed using MIS techniques between April 2008 and July 2010. Presenting symptoms, physical examination findings, and preoperative MR imaging results were obtained from medical records. Perioperative results, including blood loss, length of hospital stay, and complications were assessed. Findings at latest follow-up evaluation were also recorded. Results This report represents the first surgical series regarding pediatric lumbar microdiscectomies performed using MIS. The mean patient age was 16 years (range 14–17 years); there were 4 girls and 2 boys. Preoperative signs and symptoms of radiculopathic pain were notable in 100% of patients, and myotomal weakness was noted in 33% of patients. The first line of treatment in all patients was a period of conservative management lasting an average of 11.5 months (range 6–12 months). The mean intraoperative blood loss was 10.8 ml, and the mean postoperative length of stay was 1.3 days. There were no complications in this small series. Conclusions The treatment of pediatric lumbar disc herniation by using MIS techniques can be safe and efficacious. However, further study with a larger number of patients and longer follow-up is needed to compare outcomes between MIS and open microdiscectomies.

scholarly journals Full-Endoscopic Technique Discectomy Versus Microendoscopic Discectomy for the Surgical Treatment of Lumbar Disc Herniation

2015 ◽  
Vol 18;4 (4;18) ◽  
pp. 359-363
Author(s):  
Huilin Yang
Keyword(s):  
Retrospective Study ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Hospital Stay ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Minimally Invasive Procedures ◽  
Invasive Procedures ◽  
Microendoscopic Discectomy

Background: Full-endoscopic technique discectomy (FED) or microendoscopic discectomy (MED) are 2 widely used minimally invasive procedures for the treatment of lumbar disc herniation. However, there is insufficient literature regarding the differences between these 2 surgical procedures. Objective: To compare the clinical outcomes of 2 different minimally invasive methods—fullendoscopic technique discectomy and microendoscopic discectomy—in the surgical treatment of lumbar disc herniation. Study Design: Retrospective study. Setting: Inpatient surgery center. Methods: Data form 65 patients with lumbar disc herniation treated with one of 2 minimally invasive procedures were retrospectively analyzed. Patients were divided into 2 groups according to surgical method: the FED group (n = 35) and the MED group (n = 30). Surgery time, time kept in bed after surgery, duration of postoperative hospital stay, visual analog scale (VAS; 0 – 10), and Oswestry Disability index (ODI; 0 – 100%) were assessed and compared between the 2 groups. Results: There were no significant differences in the preoperative data between the 2 groups (P > 0.05). VAS and ODI scores improved significantly postoperatively in both groups (P < 0.05). Surgery time was longer in the FED group than in the MED group (P < 0.05). However, the FED group was superior to the MED group, with less time in bed, shorter hospital stay, and lower VAS scores one day postoperatively (P < 0.05). There were no significant differences in VAS or ODI scores at one, 3, and 12 months after surgery between the 2 groups (P > 0.05). Limitations: This is a retrospective study with a relatively short follow-up period. Conclusions: Although the clinical outcomes of the 2 surgical techniques were similar, the FED had the advantages of quicker postoperative recovery and more immediate effect. Key words: Full-endoscopic, microendoscopic, discectomy, lumbar disc herniation, minimally invasive, surgical treatment

scholarly journals Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chunxiao Wang ◽  
Yao Zhang ◽  
Xiaojie Tang ◽  
Haifei Cao ◽  
Qinyong Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operation Time ◽  
Operation Duration ◽  
The Mean

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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