Percutaneous Full Endoscopic Posterior Decompression for Revision of Lumbar Spinal Dynamic Stabilization

2021 ◽  
Author(s):  
Changkun Zheng ◽  
Zhong Liao ◽  
Weiliang cui
Keyword(s):  
Disc Herniation ◽  
Outcome Data ◽  
Dynamic Stabilization ◽  
Endoscopic Approach ◽  
Leg Pain ◽  
Foraminal Stenosis ◽  
Posterior Decompression ◽  
Endoscopic Discectomy ◽  
Poor Outcomes ◽  
Lumbar Spinal

Abstract Objective: The objective of this article was to analysis the efficacy of percutaneous full endoscopic posterior decompression for revision of lumbar spinal dynamic stabilization.Methods: Twenty consecutive patients with failed lumbar spinal dynamic stabilization presenting with leg pain that had supporting imaging diagnosis of lateral stenosis and /or residual / recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections, were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open lumbar spinal dynamic stabilization surgery for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen for foraminal stenosis, or foraminoplasty to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla. The average follow up time was, average 37.9 months, minimum 24 months. Outcome data at each visit included Macnab, VAS and ODI.Results: The average leg Visual Analog Scale improved from 8.9 ± 2.6 to 1.08± 0.7 (p < 0.005). Fifteen patients had excellent outcomes, four had good outcomes, one had fair outcomes, and no had poor outcomes, according to the Macnab criteria (Table 2). Nineteen of 20 patients had excellent or good outcomes, for an overall success rate of 95%. No patients required reoperation. There were no incidental durotomies, infections, vascular or visceral injuries. They were also relieved to be able to avoid "open" decompression.Conclusion: The transforaminal endoscopic approach is effective for failed lumbar spinal dynamic stabilization surgery due to residual/recurrent nucleus pulposus and lateral stenosis. Failed initial index surgery may involve failure to recognize patho-anatomy in the axilla of the foramen housing the traversing and the exiting nerve. The transforaminal endoscopic approach effectively decompresses the foramen and does not further destabilize the spine needing stabilization. It also avoids going through the previous surgical site.

scholarly journals Histopathological Analysis of Ligamentum Flavum in Lumbar Spinal Stenosis and Disc Herniation

2017 ◽  
Vol 11 (1) ◽  
pp. 71-74 ◽  
Author(s):  
Idiris Altun ◽  
Kasım Zafer Yüksel
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Disc Herniation ◽  
Ligamentum Flavum ◽  
Elastic Fiber ◽  
Leg Pain ◽  
Histopathological Analysis ◽  
Significant Difference ◽  
Fiber Number ◽  
Lumbar Spinal

<sec><title>Study Design</title><p>Histopathological analyses were performed in ligamentum flavum (LF) hypertrophy patients with lumbar spinal stenosis (LSS) and lumbar disc herniation (LDH).</p></sec><sec><title>Purpose</title><p>The aim of the present study was to evaluate histopathological changes in LF patients with LSS and LDH.</p></sec><sec><title>Overview of Literature</title><p>LSS is the most common spinal disorder in elderly patients. This condition causes lower back and leg pain and paresis, and occurs as a result of degenerative changes in the lumbar spine, including bulging of the intervertebral discs, bony proliferation of the facet joints, and LF thickening; among these, LF thickening is considered a major contributor to the development of LSS.</p></sec><sec><title>Methods</title><p>A total of 71 patients operated with the surgical indications of LSS and LDH were included. LF samples were obtained from 31 patients who underwent decompressive laminectomy for symptomatic degenerative LSS (stenotic group) and from 40 patients who underwent lumbar discectomy for LDH (discectomy group). LF materials were examined histopathologically, and other specimens were examined for collagen content, elastic fiber number and array, and presence of calcification.</p></sec><sec><title>Results</title><p>The stenotic and discectomy groups did not differ with regard to mean collagen concentration or mean elastic fiber number (p=0.430 and p=0.457, respectively). Mean elastic fiber alignment was 2.36±0.99 in the stenotic group and 1.38±0.54 in the discectomy group (<italic>p</italic>&lt;0.001). Mean calcification was 0.39±0.50 in the stenotic group, whereas calcification was not detected (0.00±0.00) in the discectomy group; a statistically significant difference was detected (<italic>p</italic>&lt;0.001) between groups.</p></sec><sec><title>Conclusions</title><p>LF hypertrophy in spinal stenosis may occur as a result of elastic fiber misalignment along with the development of calcification over time. Further studies determining the pathogenesis of LSS are needed.</p></sec>

182 Posterior Micro-Endoscopic Discectomy vs. ACDF for Single-level Radiculopathy: Comparative Effectiveness and Cost-Utility Analysis

Neurosurgery ◽  
2017 ◽  
Vol 64 (CN_suppl_1) ◽  
pp. 248-248 ◽  
Author(s):  
Matthew J McGirt ◽  
E Hunter Dyer ◽  
Domagoj Coric ◽  
Silky Chotai ◽  
Anthony L Asher ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indirect Cost ◽  
Disc Herniation ◽  
Comparative Effectiveness ◽  
Cervical Radiculopathy ◽  
Foraminal Stenosis ◽  
Single Level ◽  
Estimated Blood Loss ◽  
Endoscopic Discectomy ◽  
One Year

Abstract INTRODUCTION Cervical radiculopathy remains highly prevalent and costly in the U.S. healthcare system. While ACDF has remained the most popular surgical treatment modality, minimally invasive advancements such as posterior micro-endoscopic discectomy/foraminotomy (pMED) has emerged as a motion preserving and less invasive alternative. To date, the comparative effectiveness and cost-effectiveness of pMED vs. ACDF remains unclear. METHODS Patients undergoing surgery for single-level radiculopathy without myelopathy resulting from foraminal stenosis or foraminal disc herniation without instability over a one-year period were prospectively enrolled into an institutional database. Baseline, post -operative 3-months, and 12-months VAS-Arm and Neck, NDI, EQ −5D, and return to work(RTW) status were collected. Direct healthcare cost(payer perspective) and indirect cost (work-day losses multiplied by median gross-of-tax wage and benefits rate) was assessed. RESULTS >Total 20 ACDF and 28 pMED patients were identified. Baseline demographics, symptomatology, and co-morbidities were similar between the cohorts. For pMED vs. ACDF, mean length of surgery (48.1 ± 20.0 vs. 69.9 ± 11.6 minutes, P < 0.0001) and estimated blood loss (20.3 ± 9.3 vs. 31.8 ± 15.4 mL, P = 0.04) was reduced. There was no 90-day morbidity or re-admission for either cohort. One(3.6%) pMED patient required a subsequent ACDF; no patients in the ACDF cohort required re-operation by one-year. pMED and ACDF cohorts demonstrated similar improvement in arm-VAS(3.1 vs. 2.6, P = 0.66), neck-VAS(2.0 vs. 3.2, P = 0.24), NDI(9.0 vs. 6.8, P = 0.24), and EQ-5D(0.17 vs. 0.15, P = 0.82). Ability to RTW(93.8% vs. 94.1%, P = 1.0) and median time to RTW(3.7[0.9- 8.1] vs. 3.6[2.1-8.5] weeks, P = 0.85) were similar. pMED was associated with significantly reduced direct cost (p>0.001) but similar indirect cost (P = 0.43), resulting in an average total cost savings of $7689(P < 0.01) per case with similar QALY-gain (0.17 vs. 0.15, P = 0.82). CONCLUSION For single-level unilateral-radiculopathy resulting from foraminal stenosis or lateral disc herniation without segmental instability, pMED was equivalent to ACDF in safety and effectiveness. pMED represents a minimally invasive, motion preserving alternative to select patients with cervical radiculopathy without the need for implant costs with concomitant significant cost saving.

scholarly journals Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Medicina ◽  
2020 ◽  
Vol 56 (12) ◽  
pp. 710
Author(s):  
Muneyoshi Fujita ◽  
Tomoaki Kitagawa ◽  
Masahiro Hirahata ◽  
Takahiro Inui ◽  
Hirotaka Kawano ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Disc Height ◽  
Leg Pain ◽  
Height Loss ◽  
Common Disease ◽  
Low Back ◽  
Endoscopic Discectomy ◽  
Microendoscopic Discectomy

Background and objectives: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. Materials and Methods: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (n = 39) or MED (n = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); Results: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (p < 0.05) in the FED group than in the MED group, and there was less blood loss; Conclusions: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.

scholarly journals Efficacy and safety of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar spinal stenosis combined with osteoporosis

2019 ◽  
Vol 65 (6) ◽  
pp. 779-785
Author(s):  
Xiaobin Gu ◽  
Wenhui Zhu ◽  
Haiyi He ◽  
Zili Wang ◽  
Shaolong Ding ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Adverse Reactions ◽  
Leg Pain ◽  
Control Group ◽  
Efficacy And Safety ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Lumbar Spinal

SUMMARY OBJECTIVE: To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis. METHODS: Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed. RESULTS: Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05). CONCLUSIONS: PTED is safe and effective in the treatment of LSS combined with osteoporosis.

Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis

2020 ◽  
Author(s):  
Kuo-Tai Chen ◽  
Kyung-Chul Choi ◽  
Myung-Soo Song ◽  
Hussam Jabri ◽  
Yadhu K Lokanath ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Lumbar Decompression ◽  
Lateral Recess Stenosis ◽  
Endoscopic Discectomy ◽  
The Mean

Abstract BACKGROUND Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. OBJECTIVE To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. METHODS Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. RESULTS A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P &lt; .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P &lt; .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. CONCLUSION Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.

scholarly journals Short-term clinical outcomes of percutaneous transforaminal endoscopic discectomy in treating adolescents under 25 years old with massive lumbar disc herniation

2020 ◽  
Author(s):  
Hai-Chao He ◽  
Yong-jin Zhang
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Spinal Instability ◽  
Lower Limb Pain ◽  
Endoscopic Discectomy ◽  
Adolescent Patients ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract Background: In the last decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, few studies have described the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in treating adolescent massive LDH. This study aims to evaluate the surgical outcomes of PTED in treating adolescent patients with massive LDH. Methods: Between October 2012 and December 2018, retrospective analysis of 13 adolescent patients with single segment massive LDH at the Department of Spinal Surgery of Affiliated Dongyang Hospital of Wenzhou Medical University. All patients were followed up for at least 12 months (range 12–20 months). The patients’ lower limb pain was evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively, at 3 days, 1 months, 3 months, 6 month and 12 months postoperatively. Results: The VAS score for leg pain was 7.08 ±1.12 preoperatively and 3.23±1.01, 3.0 ± 1.01, and 2.62 ± 0.51, and 2.32± 0.48, and 1.46± 0.52, at 3 days, 1 months, 3 months, 6 months and 12 months postoperatively respectively. The ODI scores was 51.51 ±3.08 preoperatively and 21.74±1.15, 14.81 ± 1.50, and 2.78 ± 0.64, at 3 months, 6 months and 12 months postoperatively respectively. These postoperative scores were all significantly different when compared with preoperative scores (P < 0.001). According to the modified MacNab outcome scale, excellent was obtained in 7 patients, good was obtained in 5 patients, and fair was obtained in 1 patient, and 92.31% of these patients had excellent and good outcomes at the final follow-up. There were no complications related to surgery, and no spinal instability was detected. Conclusion: The PTED is an effective and safe surgical method for the treatment of adolescent patients with massive LDH, but high-quality randomized controlled trials are still required to further verify these findings.

scholarly journals 138 Gait Ignition Failure Syndrome Secondary to Spinal Stenosis

CNS Spectrums ◽  
2018 ◽  
Vol 23 (1) ◽  
pp. 86-87
Author(s):  
Jasir T. Nayati ◽  
Angela Rekhi ◽  
Alan R. Hirsch
Keyword(s):  
Spinal Stenosis ◽  
Exercise Therapy ◽  
Compression Fracture ◽  
Leg Pain ◽  
Foraminal Stenosis ◽  
Lower Extremity Weakness ◽  
One Year ◽  
The Right ◽  
Lumbar Spinal ◽  
As If

AbstractCase ObjectiveGait ignition failure syndrome, where immobility occurs only upon initiation of ambulation and normal gait ensues once entrained, has been reported with frontal lobe and midbrain locomotor region pathology. However, gait ignition failure syndrome secondary to lumbosacral spinal stenosis has not heretofore been described.MethodsCase Study: A 65-year-old right-handed woman underwent a right frontal parasagittal arteriovenous malformation embolization 25 years prior to presentation. After a fall resulting in a T12 and L1 compression fracture, two kyphoplasties were performed. After the second kyphoplasty, one year prior to presentation, she developed new onset of gait ignition failure, left anterior thigh pain, lower back pain at L5 with radiation to both hips, and bilateral lower extremity weakness. The gait difficulty duration correlates to the duration she is in a seated position. Upon standing, she is unable to move her legs and exhibits basophobia, feeling she may fall due to weakness and she is unable to lift up her left foot to initiate gait, as if it is glued to the floor. She is able to initiate gait after one minute, but has an unsteady scissors-gait for the first few steps. Afterwards, her gaitreturns to baseline. Anteroflexion was noted to eliminate her back and leg pain.ResultsGait examination shows inability to initiate gait after standing, feeling as if frozen. However, she demonstrated scissors-gait after 30 seconds for 3-5 steps, which gradually improved to baseline. Her quadriceps femoris reflex was absent on the right, 3+ on the left. Her Achilles reflex was absent on left. MRI indicated spinal stenosis with broad based osteophytes at T9-T12 and bilateral neural foraminal stenosis at L1-S1. Exercise therapy designed for spinal stenosis was initiated, and resulted in elimination of gaitignition failure.ConclusionGait ignition failure syndrome may not be necessarily due to frontal or midbrain dysfunction, but can be secondary to lumbosacral impairment. In this patient, dysfunctional arachnoid villi in the lumbosacral nerve roots may have led to transient increases in pressure throughout the neural axis, including the brain, and associated NPH-like symptoms, such as magnetic gait. Seeing that posture affects epidural pressure in lumbar spinal stenosis, with a decrease pressure in response to anteroflexion and reduced pain [Takahashi 1995], one can postulate that this may be a mechanism affecting the patient. Furthermore, since her symptoms are episodic and directly associated with the duration of time she is seated, one may deduce gait ignition failure to be a manifestation of cerebrospinal fluid or intracranial pressure changes influenced by posture. In addition, symptom resolution via exercise therapy strongly suggests that gait apraxia can also be a manifestation of lumbosacral dysfunction. Therefore, those with gait ignitionfailure syndrome warrant evaluation for lumbosacral pathology.Funding AcknowledgementsSmell and Taste Treatment and Research Foundation.

scholarly journals Dynesys dynamic stabilization–related facet arthrodesis

2016 ◽  
Vol 40 (1) ◽  
pp. E4 ◽  
Author(s):  
Li-Yu Fay ◽  
Peng-Yuan Chang ◽  
Jau-Ching Wu ◽  
Wen-Cheng Huang ◽  
Chun-Hao Wang ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Japanese Orthopaedic Association ◽  
Dynamic Stabilization ◽  
Leg Pain ◽  
Clinical Evaluations ◽  
Radiological Data ◽  
Spinal Segments ◽  
Lumbar Spinal ◽  
Limited Motion

OBJECTIVE Dynamic stabilization devices are designed to stabilize the spine while preserving some motion. However, there have been reports demonstrating limited motion at the instrumented level of the lumbar spine after Dynesys dynamic stabilization (DDS). The causes of this limited motion and its actual effects on outcomes after DDS remain elusive. In this study, the authors investigate the incidence of unintended facet arthrodesis after DDS and clinical outcomes. METHODS This retrospective study included 80 consecutive patients with 1- or 2-level lumbar spinal stenosis who underwent laminectomy and DDS. All medical records, radiological data, and clinical evaluations were analyzed. Imaging studies included pre- and postoperative radiographs, MR images, and CT scans. Clinical outcomes were measured by a visual analog scale (VAS) for back and leg pain, the Oswestry Disability Index (ODI), and Japanese Orthopaedic Association (JOA) scores. Furthermore, all patients had undergone postoperative CT for the detection of unintended arthrodesis of the facets at the indexed level, and range of motion was measured on standing dynamic radiographs. RESULTS A total of 70 patients (87.5%) with a mean age of 64.0 years completed the minimum 24-month postoperative follow-up (mean duration 29.9 months). Unintended facet arthrodesis at the DDS instrumented level was demonstrated by CT in 38 (54.3%) of the 70 patients. The mean age of patients who had facet arthrodesis was 9.8 years greater than that of the patients who did not (68.3 vs 58.5 years, p = 0.009). There were no significant differences in clinical outcomes, including VAS back and leg pain, ODI, and JOA scores between patients with and without the unintended facet arthrodesis. Furthermore, those patients older than 60 years were more likely to have unintended facet arthrodesis (OR 12.42) and immobile spinal segments (OR 2.96) after DDS. Regardless of whether unintended facet arthrodesis was present or not, clinical evaluations demonstrated improvement in all patients (all p < 0.05). CONCLUSIONS During the follow-up of more than 2 years, unintended facet arthrodesis was demonstrated in 54.3% of the patients who underwent 1- or 2-level DDS. Older patients (age > 60 years) were more likely to have unintended facet arthrodesis and subsequent immobile spinal segments. However, unintended facet arthrodesis did not affect the clinical outcomes during the study period. Further evaluations are needed to clarify the actual significance of this phenomenon.

scholarly journals Facet joint changes after application of lumbar nonfusion dynamic stabilization

2016 ◽  
Vol 40 (1) ◽  
pp. E6 ◽  
Author(s):  
Soo Eon Lee ◽  
Tae-Ahn Jahng ◽  
Hyun Jib Kim
Keyword(s):  
Spinal Surgery ◽  
Facet Joint ◽  
Dynamic Stabilization ◽  
Leg Pain ◽  
Adjacent Segment ◽  
Facet Joints ◽  
Joint Degeneration ◽  
Facet Joint Degeneration ◽  
Lumbar Spinal Surgery ◽  
Lumbar Spinal

OBJECTIVE The long-term effects on adjacent-segment pathology after nonfusion dynamic stabilization is unclear, and, in particular, changes at the adjacent facet joints have not been reported in a clinical study. This study aims to compare changes in the adjacent facet joints after lumbar spinal surgery. METHODS Patients who underwent monosegmental surgery at L4–5 with nonfusion dynamic stabilization using the Dynesys system (Dynesys group) or transforaminal lumbar interbody fusion with pedicle screw fixation (fusion group) were retrospectively compared. Facet joint degeneration was evaluated at each segment using the CT grading system. RESULTS The Dynesys group included 15 patients, while the fusion group included 22 patients. The preoperative facet joint degeneration CT grades were not different between the 2 groups. Compared with the preoperative CT grades, 1 side of the facet joints at L3–4 and L4–5 had significantly more degeneration in the Dynesys group. In the fusion group, significant facet joint degeneration developed on both sides at L2–3, L3–4, and L5–S1. The subjective back and leg pain scores were not different between the 2 groups during follow-up, but functional outcome based on the Oswestry Disability Index improved less in the fusion group than in the Dynesys group. CONCLUSIONS Nonfusion dynamic stabilization using the Dynesys system had a greater preventative effect on facet joint degeneration in comparison with that obtained using fusion surgery. The Dynesys system, however, resulted in facet joint degeneration at the instrumented segments and above. An improved physiological nonfusion dynamic stabilization system for lumbar spinal surgery should be developed.

scholarly journals Application of a targeted and quantificational foraminoplasty device in percutaneous transforaminal endoscopic discectomy for L5–S1 disc herniation: preliminary clinical outcomes

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Jinlong Liu ◽  
Junlong Wu ◽  
Honglei Zhang ◽  
Rui Zuo ◽  
Jiabin Liu ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Fluoroscopy Time ◽  
Low Back ◽  
Vas Score ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract Objective Percutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disc herniation (LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5–S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSYS at the L5–S1 level. Methods Between January and August of 2018, fifty-six patients with lumbar disc herniation at the single level of L5–S1 and who underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the transforaminal endoscopic surgical system (TESSYS) group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time, and fluoroscopy time were evaluated for operation efficiency. Clinical outcomes were assessed by the visual analog scale (VAS) score and Oswestry Disability Index (ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively. Results The average puncture time (5.29 ± 2.05 min), foraminoplasty time (12.82 ± 2.52 min), and fluoroscopy time (26.29 ± 5.96 s) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07 ± 3.13 min, p < 0.01; foraminoplasty time, 17.18 ± 2.92 min, p < 0.01; fluoroscopy time, 34.73 ± 6.86 s; p < 0.01). No significant differences were observed between the 2 groups in the decompression time (p = 0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoperative, in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05). Conclusion The targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disc herniation at the L5–S1 level.

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