scholarly journals Transforaminal Endoscopic Discectomy for Treatment of Central Disc Herniation: Surgical Techniques and Clinical Outcome

2018 ◽  
Vol 1 (21;1) ◽  
pp. E113-E123 ◽  
Author(s):  
Wei Zhang
Keyword(s):  
Clinical Outcome ◽  
Disc Herniation ◽  
Surgical Techniques ◽  
Posterior Longitudinal Ligament ◽  
Small Sample ◽  
Detection Technique ◽  
Herniated Disc ◽  
Central Disc ◽  
Endoscopic Discectomy

Background: Though transforaminal endoscopic discectomy has achieved a satisfactory clinical outcome in the treatment of paracentral disc herniation, it has a high failure rate for treating central disc herniation. Objective: To explore the surgical techniques of transforaminal endoscopic discectomy in treating central disc herniation and the clinical outcome based on 2-year follow-up. Study Design: A retrospective study. Setting: The Department of Spinal Surgery at the Third Hospital of Hebei Medical University in China. Methods: Sixty-nine consecutive patients (male:female = 14:9, mean age 38.8 ± 10.5 years) were enrolled in the study, all of whom underwent transforaminal endoscopic discectomy due to central disc herniation. The rod adjustment technique, apex technique, and posterior longitudinal ligament detection technique were adopted for intraoperative individualization. All of the patients were followed up for 24 months to assess the visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) scores. The postoperative segmental instability and recurrence were observed during the follow-up period as well. MacNab criteria scores were recorded both intraoperatively and at the final follow-up; postoperative complications and the surgical outcome and safety were also evaluated. Results: The herniated disc tissues were successfully removed for all patients, without revision by open surgery. Twenty-one cases (30.43%) were rated excellent, 44 (63.77%) good, 4 (5.80%) fair, and 0 (0.00%) poor upon the final follow-up, with an overall excellent-to-good rate of 86.96%. The VAS scores of low back and leg pain were all significantly lower at 3, 6, 12, and 24 months postoperatively compared to preoperatively (all P < 0.05). The JOA scores at the 3-month and 24-month postoperative follow-ups were significantly higher than the preoperative values (all P < 0.05). The ODI evaluation was significantly lower at 3 and 24 months postoperatively than preoperatively (all P < 0.05). Limitations: The retrospective nature of this study is a limitation, as well as the small sample size and short observation time. Conclusion: The application of novel surgical techniques can help improve the safety and efficacy of transforaminal endoscopic discectomy in treating central disc herniations. Intraoperative individualized application of rod adjustment technique, apex technique, or posterior longitudinal ligament detection technique is the key to satisfactory clinical outcome. Key words: Central disc herniation, rod adjustment technique, transforaminal endoscopy, minimal invasion, complication

scholarly journals Surgical Treatment of Diffuse Idiopathic Skeletal Hyperostosis (DISH) Involving the Cervical Spine: Technical Nuances and Outcome of a Multicenter Experience

2021 ◽  
pp. 219256822098827
Author(s):  
Giorgio Lofrese ◽  
Alba Scerrati ◽  
Massimo Balsano ◽  
Roberto Bassani ◽  
Michele Cappuccio ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Outcome ◽  
Waiting Times ◽  
Diffuse Idiopathic Skeletal Hyperostosis ◽  
Surgical Techniques ◽  
Rare Condition ◽  
Surgical Strategies ◽  
Bone Removal ◽  
Mild Dysphagia

Study Design: Retrospective multicenter. Objectives: diffuse idiopathic skeletal hyperostosis (DISH) involving the cervical spine is a rare condition determining disabling aero-digestive symptoms. We analyzed impact of preoperative settings and intraoperative techniques on outcome of patients undergoing surgery for DISH. Methods: Patients with DISH needing for anterior cervical osteophytectomy were collected. Swallow studies and endoscopy supported imaging in targeting bone decompression. Patients characteristics, clinico-radiological presentation, outcome and surgical strategies were recorded. Impact on clinical outcome of duration and time to surgery and different surgical techniques was evaluated through ANOVA. Results: 24 patients underwent surgery. No correlation was noted between specific spinal levels affected by DISH and severity of pre-operative dysphagia. A trend toward a full clinical improvement was noted preferring the chisel ( P = 0.12) to the burr ( P = 0.65), and whenever C2-C3 was decompressed, whether hyperostosis included that level ( P = 0.15). Use of curved chisel reduced the surgical times ( P = 0.02) and, together with the nasogastric tube, the risk of complications, while bone removal involving 3 levels or more ( P = 0.04) and shorter waiting times for surgery ( P < 0.001) positively influenced a complete swallowing recovery. Early decompressions were preferred, resulting in 66.6% of patients reporting disappearance of symptoms within 7 days. One and two recurrences respectively at clinical and radiological follow-up were registered 18-30 months after surgery. Conclusion: The “age of DISH” counts more than patients’ age with timeliness of decompression being crucial in determining clinical outcome even with a preoperative mild dysphagia. Targeted bone resections could be reasonable in elderly patients, while in younger ones more extended decompressions should be preferred.

Comparison of Outcomes Postoperation between Straight Leg Raising Test Negative and Positive Patients Who Underwent Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation

2019 ◽  
Author(s):  
Feilong Wei ◽  
Haoran Gao ◽  
Yifang Yuan ◽  
Shu Qian ◽  
Quanyou Guo ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Related Factors ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
Straight Leg Raising ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Relevant Factors

Abstract Background: Percutaneous Transforaminal Endoscopic Discectomy is used increasingly in patients with Lumbar Disc Herniation. There is little knowledge on the related factors including SLR test influencing the operation. Therefore, we designed this prospective study to explore the relevant factors influencing postoperative effect of PTED surgery.Methods: Consecutive patients with LDH who came to our hospital from August 2015 to September 2016 and received PTED surgery. 4 kinds of scales including VAS (lumbar/leg), ODI and JOA were measured and reassessed at 1 day, 3 months, 6 months, 12months and 36 months after the PTED to assess their surgical outcomes. Results: All the patients had successful surgery. ODI and VAS (lumbar/leg) decreased in all patients and groups. And there was a statistically significant difference in each postoperative follow-up compared with that before surgery in every visit. In addition, the increase of JOA in postoperation was statistically significant compared with that before surgery. And, there is statistically significant difference between the three subpopulations (patients with SLR Positive (0°-30°), SLR Positive (31°-60°) and SLR Negative (61°-) in the changes of the scores of VAS(leg), ODI and JOA. However, there is no statistically significant difference between the three subpopulations (patients with SLR Positive (0°-30°), SLR Positive (31°-60°) and SLR Negative (61°--RRB- in the changes of the score of VAS(lumbar). Conclusions: PTED showed great effect on treating patients with lumbar disc herniation. And the main scale score such as VAS(leg). ODI and JOA showed that there is a statistically significant difference between the three subpopulations treated by PTED. Patients with SLR negative may get greater benefit from PTED.

Clinical Outcome after Surgical Treatment of the Central Disc Herniation

2006 ◽  
Vol 13 (2) ◽  
pp. 93
Author(s):  
Jae Chul Lee ◽  
Young-Il Cho ◽  
Jun-Seo Nam ◽  
Jung-Woo Ji ◽  
Yon-Il Kim ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Clinical Outcome ◽  
Disc Herniation ◽  
Central Disc

Unilateral facetectomy approach for lateral lumbar disc herniation

1991 ◽  
Vol 74 (5) ◽  
pp. 754-756 ◽  
Author(s):  
Eddy Garrido ◽  
P. Noel Connaughton
Keyword(s):  
Disc Herniation ◽  
Lumbar Fusion ◽  
Lumbar Disc ◽  
Herniated Disc ◽  
Spinal Instability ◽  
Content Type ◽  
X Ray ◽  
Flexion And Extension ◽  
Fine Print

✓ Forty-one patients with herniated lumbar discs in a lateral location underwent unilateral complete facetectomy for removal of their disc herniation. The diagnosis was made by computerized tomography in all patients. The follow-up period varied between 4 and 60 months, with an average of 22.4 months. All patients underwent dynamic lumbar spine x-ray films with flexion and extension exposures at various times during their follow-up period. The results were excellent in 35 patients, good in three, and poor in three. One patient suffered spinal instability postoperatively and required lumbar fusion because of back pain. Unilateral facetectomy gives an excellent view of the affected nerve root and the herniated disc, and the risk of spinal instability is very low.

Radiological changes of the operated and adjacent segments following cervical arthroplasty after a minimum 24-month follow-up: comparison between the Bryan and Prodisc-C devices

2010 ◽  
Vol 13 (3) ◽  
pp. 299-307 ◽  
Author(s):  
Kyeong-Sik Ryu ◽  
Chun-Kun Park ◽  
Sung-Chul Jun ◽  
Han-Yong Huh
Keyword(s):  
Clinical Outcome ◽  
Range Of Motion ◽  
Posterior Longitudinal Ligament ◽  
Occurrence Rate ◽  
Cervical Arthroplasty ◽  
Functional Spinal Unit ◽  
Bryan Disc ◽  
Radiological Changes ◽  
Index Level

Object The purposes of this retrospective study were to determine the radiological changes at the index and adjacent levels after cervical arthroplasty using the Bryan disc and Prodisc-C disc after a minimum 24 months follow-up, and to demonstrate the possible clinical factors related to these changes. Methods Following single-level cervical arthroplasty using either the Bryan disc or Prodisc-C, the degree of facet degeneration and other radiological changes at the index and adjacent levels were assessed by observing radiographs and CT scans at a minimum 24 months after the operations. These findings were determined in relation to the clinical outcome, various perioperative factors, and prosthesis factors. Thirty-six patients were included in this investigation (19 in the Bryan disc group and 17 in the Prodisc-C group). Results At the index level, progression of facet arthrosis (PFA) was observed in 7 of 36 levels (1 level with the Bryan disc, 6 with the Prodisc-C). At adjacent levels, PFA was minimally observed. Heterotopic ossification (HO) was observed at 19 levels (11 with the Bryan disc, 8 with Prodisc-C). Progression of facet arthrosis at the index segments was positively related to malposition of the prosthesis on the frontal plane, and decreased postoperative functional spinal unit range of motion at the index level. Occurrence of HO was correlated with the preoperative calcification of the posterior longitudinal ligament at the operated level, regardless of prosthesis type. Clinical outcome and the occurrence of PFA or HO did not show any significant relationship. Conclusions This study demonstrates that the incidence of PFA at the index level is 19.4% after a minimum 24-month follow-up, and occurs more frequently in the Prodisc-C group. Progression of facet arthrosis is related to less functional spinal unit range of motion and anterior placement of the prosthesis. The occurrence rate of HO is high, regardless of the type of prosthesis, and it is significantly correlated with preoperative calcification of the posterior longitudinal ligament at the operated level.

Anterior Lumbar Microdiscectomy and Interbody Fusion for the Treatment of Recurrent Disc Herniation

Neurosurgery ◽  
2001 ◽  
Vol 48 (2) ◽  
pp. 334-338 ◽  
Author(s):  
A. Giancarlo Vishteh ◽  
Curtis A. Dickman
Keyword(s):  
Interbody Fusion ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Radicular Pain ◽  
Neurological Deficits ◽  
Herniated Disc ◽  
X Rays ◽  
Lumbar Microdiscectomy ◽  
Disc Herniations

Abstract OBJECTIVE To demonstrate the feasibility of anterior lumbar microdiscectomy in patients with recurrent, sequestered lumbar disc herniations. METHODS Between 1997 and 1999, six patients underwent a muscle-sparing “minilaparotomy” approach and subsequent microscopic anterior lumbar microdiscectomy and fragmentectomy for recurrent lumbar disc extrusions at L5–S1 (n = 4) or L4–L5 (n = 2). A contralateral distraction plug permitted ipsilateral discectomy under microscopic magnification. Effective resection of the extruded disc fragments was accomplished by opening the posterior longitudinal ligament. Interbody fusion was performed by placing cylindrical threaded titanium cages (n = 4) or threaded allograft bone dowels (n = 2). RESULTS There were no complications, and blood loss was minimal. Follow-up magnetic resonance imaging revealed complete resection of all herniated disc material. Plain x-rays revealed excellent interbody cage position. Radicular pain and neurological deficits resolved in all six patients (mean follow-up, 14 mo). CONCLUSION Anterior lumbar microdiscectomy with interbody fusion provides a viable alternative for the treatment of recurrent lumbar disc herniations. Recurrent herniated disc fragments can be removed completely under direct microscopic visualization, and interbody fusion can be performed in the same setting.

scholarly journals Preliminary Report of Partial-breast Irradiation Following Neoadjuvant Chemotherapy from COMBAT-NEO: Clinical Outcome of Multicatheter BrAchyTherapy after NEOadjuvant Chemotherapy

2021 ◽  
pp. 149-155
Author(s):  
Kazuhiko Sato ◽  
Hiromi Fuchikami ◽  
Naoko Takeda ◽  
Takahiro Shimo ◽  
Masahiro Kato ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Clinical Outcome ◽  
Adverse Events ◽  
Small Sample ◽  
Single Stage ◽  
Partial Breast Irradiation ◽  
Wound Complications ◽  
Tumor Control ◽  
Breast Irradiation

Background: Breast-conserving therapy (BCT) with partial-breast irradiation (PBI) has become a standard alternative to whole-breast irradiation. Recently, neoadjuvant chemotherapy (NACT) has been widely performed for early breast cancer. Although BCT using perioperative PBI decreased invasiveness and geographic miss, risks of adverse events and local recurrence remain a concern for patients receiving NACT. Thus, a prospectively registered study, the Clinical Outcome of Multicatheter BrAchyTherapy after NEOadjuvant chemotherapy (COMBAT-NEO), was conducted.Methods: Patients who underwent BCT using multicatheter-interstitial brachytherapy (MIB) by intraoperative catheter implant were analyzed. Early and late adverse events (AEs) including higher grade skin toxicities and wound complications, and tumor control of patients receiving NACT were evaluated in comparison with adjuvant chemotherapy (ACT) and no chemotherapy (no-CT).Results: Between April 2017 and February 2020, 265 consecutive patients who received single-stage BCT were evaluated, including 13 NACT (4.9%), 68 ACT (25.7%), and 184 no-CT (69.4%). The median follow-up time and age were 30.0 months and 59.0 years, respectively. All patients were followed up for at least 12 months. Although AEs in NACT, ACT, and no-CT were observed in 1 (7.7%), 5 (7.4%), and 11 (6.0%) patients, respectively (p = 0.91) and there was no acute AE in NACT patients. Overall, 3 (1.1%) ipsilateral and 1 (0.4%) contralateral breast tumor recurrences were observed in no-CT patients. There were no regional and distant recurrences.Conclusion: Although this pilot study was based on a small sample size with short follow-up, these preliminary results support the study of a single-stage BCT with MIB-PBI following NACT.

scholarly journals Initial Clinical Outcomes of Percutaneous FullEndoscopic Lumbar Discectomy Using an Interlaminar Approach at the L4-L5

2017 ◽  
Vol 4 (20;4) ◽  
pp. E507-E512 ◽  
Author(s):  
Jun-ichiro Nakamura
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Disc Herniation ◽  
Operative Time ◽  
Small Sample ◽  
Lumbar Discectomy ◽  
Interlaminar Approach ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
The Mean

Background: Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported. Objective: This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF. Study Design: Retrospective evaluation. Setting: An urban minimally invasive spine hospital. Methods: Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1. Results: The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.). Limitations: A small sample size and a short follow-up period. Conclusions: The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation. Keywords: Percutaneous full-endoscopic lumbar discectomy, interlaminar approach, clinical outcome, herniated nucleus pulpous, MacNab criteria, intracanalicular disc herniation, learning curve

scholarly journals Comparison of the histopathological differences between the spinal material and posterior longitudinal ligament in patients with lumbar disc herniation: A focus on the etiopathogenesis

2021 ◽  
Vol 41 (2) ◽  
pp. 115-120
Author(s):  
Asuman Kilitci ◽  
Ziya Asan ◽  
Abdulbaki Yuceer ◽  
Omer Aykanat ◽  
Fatih Durna
Keyword(s):  
Disc Degeneration ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Small Sample ◽  
Histopathological Changes ◽  
Surgical Operation ◽  
Mri Findings ◽  
Disc Material

BACKGROUND: Lumbar disc herniation (LDH) occurs owing to the inability of the posterior longitudinal ligament (PLL) to preserve the disc material within the intervertebral space. There is apparently no study that has investigated the histopathological changes occurring in both PLL and disc material in patients with LDH. OBJECTIVE: Investigate and compare the histopathological changes occurring in PLL and disc material of the patients who underwent a surgical operation for LDH. DESIGN: Descriptive, cross-sectional. SETTING: Pathology and neurosurgery departments of a tertiary health care institution PATIENTS AND METHODS: The study included patients who underwent surgical operation for LDH from January 2018 to May 2019 and whose PLL and disc material were removed together, and had disc degeneration findings that were radiologically and histologically concordant. MAIN OUTCOME MEASURES: PLL degeneration scores according to the histopathological findings, changes in disc materials according to the MRI findings, disc degeneration scores according to the histo-pathological findings. SAMPLE SIZE: 50. RESULTS: MRI and histological examinations showed fully degenerated black discs (Grade 2) in 12 patients, partially degenerated discs (Grade 1) in 29 patients and fresh/acute discs (Grade 0) in 9 patients. The PLL showed grade 0 degeneration in 2 patients, grade 1 degeneration in 23 patients, and grade 2 degeneration in 25 patients. PLL degeneration grades were higher than the disc degeneration grades ( P =.002). CONCLUSION: Longitudinal ligament degeneration can play a significant role in the pathogenesis of LDH. To the best of our knowledge, this study represents the first to focus on the histopathological changes occurring in both the PLL and disc material in patients with LDH. LIMITATIONS: Small sample, retrospective CONFLICT OF INTEREST: None.

scholarly journals Analysis of curative effect: percutaneous transforaminal endoscopic discectomy for lumbar disc herniation with buttock pain as the main symptom

2021 ◽  
Author(s):  
Jun-Yan An ◽  
Jun Zhang ◽  
Jiu-Ping Wu ◽  
Tong Yu ◽  
Wu Xue ◽  
...  
Keyword(s):  
Clinical Symptom ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Average Length ◽  
Lumbar Disc ◽  
Common Disease ◽  
Buttock Pain ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract Background . Lumbar disc herniation (LDH) is a common disease in spinal surgery which often causes acute radicular pain. However, LDH with buttock pain (BP) as the main clinical symptom is rare. Herein, we retrospectively evaluated the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of LDH with the buttock as the primary clinical symptom. Methods . Totally 12 patients have LDH (L4-5) with BP who underwent PTED from January 2019 to June 2020 were enrolled. All patients performed magnetic resonance imaging (MRI) and computed tomography (CT) preoperatively, 1 week postoperatively, and at follow-up. The pain relieve were evaluated by the Visual analog scale (VAS), the functional recovery was assessed by Oswestry disability index (ODI) and Roland-Morris questionnaire (RMQ). Parameters were evaluated preoperatively, immediately after surgery, 1 month, 3 months and 6 months after surgery, respectively. Moreover, the lumbar function was determined by modified MacNab criteria. Results . Pain relieve was found in 11 patients postoperatively. The VAS, ODI and RMQ scores were improved significantly at the latest follow up visit compared to preoperative (P < 0.05). One patient suffered from LDH recurrence one month after operation and received revision surgery, then achieved satisfied effect. Two patients experienced residual BP after operation and obtained good clinical outcomes by conservative treatment. No other surgical complications were found during follow up period. The average length of follow-up was 6.68 ± 0.67 months. Conclusion. PTED is a safe and efficacious method in treating LDH with BP.

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