scholarly journals Treatment of Calcified Lumbar Disc Herniation by Intervertebral Foramen Remolding a Retrospective Study

2021 ◽  
Author(s):  
Ao-lin Yuan ◽  
Xin Shen ◽  
Bin Chen
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Perioperative Outcomes ◽  
Intervertebral Foramen ◽  
Oswestry Disability Index Score ◽  
Disc Herniations ◽  
Dural Leak ◽  
Vas Scores ◽  
Endoscopic Lumbar Discectomy

Abstract Background: The percutaneous intervertebral foramen mirror technology is a new solution for lumbar disorders. However, like other minimally-invasive treatments for calcified lumbar discs, it is still controversial. The aim of this study was to investigate the use of the percutaneous intervertebral foramen lens technology for secondary molding of the intervertebral foramen in the treatment of calcified lumbar discs. Methods: The study included 50 patients aged (mean ± standard deviation) 49.9 ± 14.5 years, 30 (60%) females, who were diagnosed with calcified lumbar disc herniation by computed tomography and magnetic resonance imaging. Patients underwent a percutaneous endoscopic lumbar discectomy surgery in our hospital from January 1, 2017 to December 31, 2019. Demographic characteristics before the surgery and perioperative outcomes were retrospective reviewed. The treatment outcome was analyzed using the visual analog scale (VAS) score, the Oswestry Disability Index score, and modified Macnab criteria. Results: We evaluated those patients who showed significant improvement in both the VAS and ODI scores after the surgery and maintained relatively low ODI and VAS scores during subsequent follow-ups. Ninety-four percent of patients rated the results as "excellent" or "good" according to the modified Macnab criteria at the 3-month follow-up. One patient developed neck pain during the surgery, which was diagnosed as spinal hypertension syndrome, and the surgery was suspended until the patient improved. No patient had a dural leak, infection, or other related complications. Conclusions: Our results indicate that transforaminal remolding is effective in the treatment of calcified lumbar disc herniations, with few intraoperative and postoperative complications.Our results indicate that secondary reconstruction of the intervertebral foramen under visual conditions using microscopic knife is an effective method for treating calcified lumbar disc herniation, with few intraoperative and postoperative complications.

Far-lateral Lumbar Disc Herniation: The Microsurgical Transmuscular Approach

Neurosurgery ◽  
2004 ◽  
Vol 54 (4) ◽  
pp. 939-942 ◽  
Author(s):  
Enrico Tessitore ◽  
Nicolas de Tribolet
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lateral Approach ◽  
Good Knowledge ◽  
Intervertebral Foramen ◽  
Bone Removal ◽  
Far Lateral Approach ◽  
Disc Herniations ◽  
Far Lateral

Abstract INTRA- AND EXTRAFORAMINAL disc herniations can be treated via a lateral approach. The far-lateral approach is a muscle-splitting approach that allows surgeons to reach the disc herniation without any facet bone removal. The target of the surgical exposure is the isthmus. Good knowledge of the anatomic features of the intervertebral foramen and intertransverse space is mandatory. The transmuscular approach is discussed. We provide illustrations and a video to emphasize some operative aspects.

scholarly journals Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases

2018 ◽  
Vol 1 (21;1) ◽  
pp. E401-E408 ◽  
Author(s):  
Byapak Paudel
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Surgical Success ◽  
Disc Herniations ◽  
Endoscopic Lumbar Discectomy

Background: Lumbar disc herniation (LDH) is being treated with limited indication by percutaneous full endoscopic lumbar discectomy. However, microscopic lumbar discectomy (MLD) is still considered as a gold standard. Objective: With the advances in spinal endoscopic instruments and surgical techniques, all LDHs have now become operable with percutaneous full endoscopic lumbar discectomy procedure. We report the results of percutaneous full endoscopic lumbar discectomy (PELD) for all patients diagnosed with LDH, including severely difficult and extremely difficult LDH cases who visited our clinic with leg pain and lower back pain. Study Design: Retrospective study of consecutive prospective patients. Setting: Spine center, Nanoori Suwon Hospital, Suwon, Korea. Methods: Electronic medical records of 98 consecutive patients (104 levels) who underwent surgery from October 2015 to May 2016, by PELD for different LDHs either by percutaneous endoscopic transforaminal lumbar discectomy (PETLD) or percutaneous endoscopic interlaminar lumbar discectomy (PEILD) approach were reviewed retrospectively. The L5-S1 level was accessed with PEILD approach and the other levels were accessed with PETLD approach. Outcomes were analyzed utilizing the visual analog scale (VAS), Oswestry disability index (ODI), Mac Nab Criteria and endoscopic surgical success grade/score. Results: There were 75 (72.1%) men and 29 (27.9%) women patients with a mean age of 48.12 ± 15.88 years. Follow-up range from a minimum of 10 to 15 months (mean 12.77 ± 1.84 months). Most of the LDHs were located at L4-5 level. There were 76% severely difficult and extremely difficult cases. PETLD was the choice of approach in most of the cases (78 cases, 75%). VAS decreased significantly. ODI improved from preoperative 54.67 ± 7.52 to 24.50 ± 6.45 at last follow-up. 96.1% good to excellent result was obtained as per Mac Nab criteria. 98.1% of patients were managed with a successful to completely successful grade according to the endoscopic surgical success grading/ scoring. Two cases (1.9%) developed transient motor weakness. Limitation: Retrospective analysis of consecutive prospective patients. Conclusion: With more than 96% success (98.1% as per endoscopic success grading/scoring) all kinds of LDHs, including severely difficult and extremely difficult LDHs, are accessible by the PELD (PETLD and PEILD) technique. PELD can now be considered an alternative to microscopic lumbar discectomy (MLD) in the treatment of all kinds of disc herniations with the added benefits of keyhole surgery even for severely difficult and extremely difficult LDH cases. Key words: Lumbar disc herniation (LDH), percutaneous endoscopic lumbar discectomy (PELD), percutaneous endoscopic transforaminal lumbar discectomy (PETLD), percutaneous endoscopic interlaminar discectomy (PEILD), evolution of PELD, difficult LDH, highly migrated LDH, high canal compromised LDH, revision LDH, LDH with discal cyst, calcified LDH

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 A Study of Lumbar Disc Herniation and Facet Joint Asymmetry

2019 ◽  
Vol 103 (1-2) ◽  
pp. 87-94
Author(s):  
Qi Lai ◽  
Yuan Liu ◽  
Runsheng Guo ◽  
Xin Lv ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Patients Âgés ◽  
Lower Lumbar Spine ◽  
Significant Difference ◽  
Facet Joint Degeneration ◽  
Disc Herniations ◽  
Lumbar Facet

Purpose: To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine. Methods: A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type. Results: At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P &gt; 0.05). Conclusion: Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.

scholarly journals Genotypic and Antimicrobial Characterisation ofPropionibacterium acnesIsolates from Surgically Excised Lumbar Disc Herniations

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Jess Rollason ◽  
Andrew McDowell ◽  
Hanne B. Albert ◽  
Emma Barnard ◽  
Tony Worthington ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Type Ii ◽  
Type Ia ◽  
Disc Herniations ◽  
Typing Methods ◽  
Human Infections ◽  
Clinical Conditions

The anaerobic skin commensalPropionibacterium acnesis an underestimated cause of human infections and clinical conditions. Previous studies have suggested a role for the bacterium in lumbar disc herniation and infection. To further investigate this, five biopsy samples were surgically excised from each of 64 patients with lumbar disc herniation.P. acnesand other bacteria were detected by anaerobic culture, followed by biochemical and PCR-based identification. In total, 24/64 (38%) patients had evidence ofP. acnesin their excised herniated disc tissue. UsingrecAand mAb typing methods, 52% of the isolates were type II (50% of culture-positive patients), while type IA strains accounted for 28% of isolates (42% patients). Type III (11% isolates; 21% patients) and type IB strains (9% isolates; 17% patients) were detected less frequently. The MIC values for all isolates were lowest for amoxicillin, ciprofloxacin, erythromycin, rifampicin, tetracycline, and vancomycin (≤1mg/L). The MIC for fusidic acid was 1-2 mg/L. The MIC for trimethoprim and gentamicin was 2 to ≥4 mg/L. The demonstration that type II and III strains, which are not frequently recovered from skin, predominated within our isolate collection (63%) suggests that the role ofP. acnesin lumbar disc herniation should not be readily dismissed.

scholarly journals Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

2016 ◽  
Vol 24 (1) ◽  
pp. 48-53 ◽  
Author(s):  
Ulrich Hubbe ◽  
Pamela Franco-Jimenez ◽  
Jan-Helge Klingler ◽  
Ioannis Vasilikos ◽  
Christoph Scholz ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Minimally Invasive ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Operating Time ◽  
Leg Pain ◽  
P Value ◽  
Vas Scores ◽  
Recurrent Lumbar Disc Herniation

OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

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