Percutaneous Transforaminal Endoscopic Diskectomy for Lumbar Disk Herniation: Young (Age <60 years) versus Older (Age ≥60 years) Patients

Background We compare the differences in the efficacy of percutaneous transforaminal endoscopic diskectomy (PTED) between the younger (age <60 years) and older (age ≥60 years) patients with lumbar disk herniation (LDH). Methods From December 2016 to December 2017, 128 patients with symptomatic LDH underwent PTED and were followed up. Forty-four 60 years old and above, including 19 males and 25 females with an average age of 68.7 (61–82) years, were classified as the elderly age group. Eighty-four patients younger than 60 years were classified as the young age group, which included 48 males and 36 females with an average age of 44.7 (16–58) years. The visual analog scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores, and satisfaction rates of the two groups before and after surgery were compared. Results The operation was completed successfully in both groups. The average follow-up times of the elderly and young age groups were 18.47 ± 2.62 (12–23) and 17.90 ± 3.27 (12–23) months, respectively. One patient in the young age group had recurrence 7 months after surgery, and the symptoms were relieved after PTED was performed again. Two patients with nerve root injury after surgery in the young age group completely recovered after 2 months of conservative treatment. There were no significant surgical complications in the elderly age group. There was no significant difference in postoperative VAS, JOA, and MacNab scores between the two groups. The MacNab scores in the elderly age group were excellent for 28 patients, good for 10 patients, and fair for 6 patients; the satisfaction rate was 86.3%. In the young age group, scores were excellent for 63 patients, good for 14 patients, fair for 5 patients, and poor for 2 patients; the satisfaction rate was 91.7%. Conclusion The clinical effectiveness of PTED for treatment of LDH in both elderly and young patients is satisfactory. Age is not a predictor of poor outcomes of PTED.

Preoperative ODI and Intake of Analgesics Predict Outcome after Lumbar Microdiskectomy: Results from a Prospective Register

Background Lumbar disk herniation (LDH) typically causes leg pain and neurologic deficits, but can also be a source of low back pain (LBP). Lumbar microdiskectomy (LMD) is among the most common neurosurgical procedures to relieve radicular symptoms. It is important for both surgeon and patient to understand potential predictors of outcome after LMD. The aim of this study was to investigate if the presence and intensity of preoperative LBP, the ODI score, and analgesic intake can predict the outcome of patients undergoing LMD. Methods This is a single-center retrospective study based on the analysis of prospectively acquired data of patients in the SwissDisc Registry. A total of 685 surgeries on 640 patients who underwent standardized LMD at our institution to treat LDH were included in this study. We performed multivariable linear regression analysis to determine preoperative predictors for patient outcomes based on the Oswestry Disability Index (ODI) scores, recorded on average 39.77 (±33.77) days after surgery. Results Our study confirmed that surgery overall improves patient degree of disability as measured by ODI score. Following model selection using Aikake Information Criterion (AIC), we observed that higher preoperative ODI scores (β: 0.020 [95% CI: 0.008 to 0.031]) and higher number of analgesic medication usage by patients prior to surgery (β: 0.236 [95% CI: 0.057 to 0.415]) were both associated with an increased postoperative ODI score. Conclusion LDH surgery generally improves patient degree of disability. The analysis of patients with a high preoperative ODI score and increased intake of analgesics before surgery predicted a worsening of patients' disability after LMD in this subgroup.

Hypertrophy of the ligamentum flavum in lumbar spinal canal stenosis is associated with abnormal accumulation of specific lipids

Ligamentum flavum hypertrophy (HLF) is the most important component of lumbar spinal canal stenosis (LSCS). Analysis of hypertrophied ligamentum flavum (HLF) samples from patients with LSCS can be an important que. The current study analyzed the surgical samples of HLF samples in patients with LCSC using quantitative and qualitative high performance-liquid chromatography and mass spectrometry. We collected ligamentum flavum (LF) tissue from twelve patients with LSCS and from four patients with lumbar disk herniation (LDH). We defined LF from LSCS patients as HLF and that from LDH patients as non-hypertrophied ligamentum flavum (NHLF). Total lipids were extracted from the LF samples and evaluated for quantity and quality using liquid chromatography and mass spectrometry. The total lipid amount of the HLF group was 3.6 times higher than that of the NHLF group. Phosphatidylcholines (PCs), ceramides (Cers), O-acyl-ω-hydroxy fatty acids (OAHFAs), and triglycerides (TGs) in the HLF group were more than 32 times higher than those of the NHLF group. PC(26:0)+H+, PC(25:0)+H+, and PC(23:0)+H+ increased in all patients in the HLF group compared to the NHLF group. The thickness of the LF correlated significantly with PC(26:0)+H+ in HLF. We identified the enriched specific PCs, Cers, OAHFAs, and TGs in HLF.

Diagnostic accuracy of color-coded virtual noncalcium reconstructions derived from portal venous phase dual-energy CT in the assessment of lumbar disk herniation

Objectives To investigate the diagnostic accuracy of color-coded contrast-enhanced dual-energy CT virtual noncalcium (VNCa) reconstructions for the assessment of lumbar disk herniation compared to unenhanced VNCa imaging. Methods A total of 91 patients were retrospectively evaluated (65 years ± 16; 43 women) who had undergone third-generation dual-source dual-energy CT and 3.0-T MRI within an examination interval up to 3 weeks between November 2019 and December 2020. Eight weeks after assessing unenhanced color-coded VNCa reconstructions for the presence and degree of lumbar disk herniation, corresponding contrast-enhanced portal venous phase color-coded VNCa reconstructions were independently analyzed by the same five radiologists. MRI series were additionally analyzed by one highly experienced musculoskeletal radiologist and served as reference standard. Results MRI depicted 210 herniated lumbar disks in 91 patients. VNCa reconstructions derived from contrast-enhanced CT scans showed similar high overall sensitivity (93% vs 95%), specificity (94% vs 95%), and accuracy (94% vs 95%) for the assessment of lumbar disk herniation compared to unenhanced VNCa images (all p > .05). Interrater agreement in VNCa imaging was excellent for both, unenhanced and contrast-enhanced CT (κ = 0.84 vs κ = 0.86; p > .05). Moreover, ratings for diagnostic confidence, image quality, and noise differed not significantly between unenhanced and contrast-enhanced VNCa series (all p > .05). Conclusions Color-coded VNCa reconstructions derived from contrast-enhanced dual-energy CT yield similar diagnostic accuracy for the depiction of lumbar disk herniation compared to unenhanced VNCa imaging and therefore may improve opportunistic retrospective lumbar disk herniation assessment, particularly in case of staging CT examinations. Key Points • Color-coded dual-source dual-energy CT virtual noncalcium (VNCa) reconstructions derived from portal venous phase yield similar high diagnostic accuracy for the assessment of lumbar disk herniation compared to unenhanced VNCa CT series (94% vs 95%) with MRI serving as a standard of reference. • Diagnostic confidence, image quality, and noise levels differ not significantly between unenhanced and contrast-enhanced portal venous phase VNCa dual-energy CT series. • Dual-source dual-energy CT might have the potential to improve opportunistic retrospective lumbar disk herniation assessment in CT examinations performed for other indications through reconstruction of VNCa images.

P.218 Patient reported outcomes following surgery for lumbar disk herniation: comparison of a universal and multitier health care system.

Background: Canada has a universal health care system that is funded by the government while the United States utilizes a combined public and private payer system. The purpose of this study is to investigate whether there are differences in clinical outcomes between those surgically treated for lumbar disk herniation in Canada as compared to the United States. Methods: Surgical lumbar disk herniation patients enrolled in the Canadian Spine Outcome Research Network (CSORN) prospective registry. were compared with the surgical cohort enrolled in the Spine Patients Outcome Research Trial (SPORT) study. Spine-related patient reported outcomes (PROs) were compared at 3 months and 1 year. Results: The CSORN cohort consisted of 443 patients and the SPORT cohort was made up of 573 patients. Patients in the CSORN cohort were older (p<0.001), and were more likely to be employed (p=0.003). The CSORN cohort demonstrated significantly greater rates of satisfaction after surgery at 3 months (87.2% vs. 65.5%, p=0.003) and 1 year (85.6% vs. 69.0%, p<0.0001). The CSORN cohort was a significant independent predictor of patient satisfaction at 1 year. Conclusions: Patients undergoing surgical treatment for lumbar disc herniation in Canada reported higher rates of satisfaction at 3 months and 1 year post-operatively compared to the United States.

Are There Correlations Between Facet Joint Parameters and Lumbar Disk Herniation Laterality in Young Adults?

Background: We aimed to determine whether there is an association, in young adults, between the occurrence of lumbar disk herniation（LDH）at a given segment and the segment’s facet joint parameters [facet orientation (FO) and tropism (FT)]. In addition, associations between facet joint parameters in the corresponding segment and LDH laterality were also investigated.Methods: We retrospectively analyzed data from 529 patients who were between 18 and 35 years old, who had experienced single-level LDH (L4–5 or L5–S1) between June 2017 and December 2019, and with less than 2 years of clinical history. We included an additional 122 patients with no history of LDH as an age-matched control group. LDH were classified by laterality (left-sided, right-sided, or central herniation). At each level (L4–L5 or L5–S1 segments), we investigated the relationship between facet joint parameters and herniation laterality. Results: FOA values at the L4–L5 level and the L5–S1 level were significantly lower and FT was higher for the LDH group compared with those for the control group. The level at which LDH occurred, FOL, FOR, and FT differed significantly among the three groups. There was a significant association between herniation laterality and FO at the L4–L5 level but not at the L5–S1 level.Conclusions: Abnormal facet joint parameters are significantly associated with LDH. Young adults with higher FT should be paid more attention, to prevent the occurrence of LDH. At the L4–L5 level, intervertebral disk herniation tended to occur ipsilateral to the side with a lower facet joint angle when FT was present.

Improving radiologists’ and orthopedists’ QoE in diagnosing lumbar disk herniation using 3D modeling

<p>This article studies and analyzes the use of 3D models, built from magnetic resonance imaging (MRI) axial scans of the lumbar intervertebral disk, that are needed for the diagnosis of disk herniation. We study the possibility of assisting radiologists and orthopedists and increasing their quality of experience (QoE) during the diagnosis process. The main aim is to build a 3D model for the desired area of interest and ask the specialists to consider the 3D models in the diagnosis process instead of considering multiple axial MRI scans. We further propose an automated framework to diagnose the lumber disk herniation using the constructed 3D models. We evaluate the effectiveness of increasing the specialists QoE by conducting a questionnaire on 14 specialists with different experiences ranging from residents to consultants. We then evaluate the effectiveness of the automated diagnosis framework by training it with a set of 83 cases and then testing it on an unseen test set. The results show that the the use of 3D models increases doctors QoE and the automated framework gets 90% of diagnosis accuracy.</p>

A Retrospective Comparative Study of Local Anesthesia Only and Local Anesthesia with Sedation for Percutaneous Endoscopic Lumbar Discectomy

The purpose of this study was to compare surgical experience and clinical outcomes of lumbar disk herniation (LDH) patients treated with percutaneous endoscopic lumbar discectomy (PELD) using local anesthesia only and local anesthesia with sedation. Ninety-two consecutive LDH patients were divided into four groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Mean arterial pressure (MAP), heart rate (HR), Ramsay score and VAS score were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperative (T4). Surgical duration, hospitalization and MacNab criteria were evaluated. In control group, MAP and HR at T2 and T3 were higher than T1 (P < 0.05). In Dex, Oxy, and Dex + Oxy groups, MAP and HR at T2, T3, T4 were lower than T1, but Ramsay scores at T2, T3, T4 were higher than T1 (P < 0.05). VAS scores in all groups were improved postoperative (p>0.05). The clinical outcomes have no significant differences among the four groups (P > 0.05). We concluded that the combination of dexmedetomidine and oxycodone under local anesthesia is an effective method to improve surgical experience and reduce anxiety in suitable LDH patients.