Removal of calcified lumbar disc herniation with endoscopic-matched ultrasonic osteotome – Our preliminary experience
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Abstract:
Objective: To evaluate the clinical efficacy, practicability, and safety of an ultrasonic osteotome for percutaneous transforaminal endoscopic discectomy (PTED) in patients with calcified lumbar disc herniation (CLDH).Methods: A total of 25 CLDH patients who underwent PTED at our department between December 2017 and August 2018 were analyzed retrospectively. Post-operative lumbar spine CT was used to evaluate residual calcification. Efficacy was evaluated by pre- and post-operative with the pain visual analog scale (VAS), Oswestry disability index (ODI), and the Modified MacNab Scale; the incidence of intra- and postoperative complications was also analyzed.Results: All procedures were successfully completed and none of the patients was lost to follow-up. Postoperative CT verified the successful removal of calcified protrusions. VAS and ODI scores improved significantly after surgery. Based on the Modified MacNab scale, >90% patients achieved good or excellent outcomes. There were no complications such as dural tear and infection. Seven patients had varying degrees of postoperative dysesthesia. One patient experienced recurrence of herniation within 1 week after operation; successful recovery was achieved after repeat PTED.Conclusions: Use of this ultrasonic osteotome for PTED facilitated effective removal of calcified disc protrusion, relieved nerve compression, and protected the adjacent neurovascular tissues. The instrument may help expand the indications for endoscopic surgery and avoid open surgery for some CLDH patients.Keywords:
Osteotome
Oswestry Disability Index
Dysesthesia
Lumbar disc herniation
Lateral recess
Discectomy
Objective To study the therapeutic effects of microendoscopic discectomy with smallincision fenestration discectomy for lumbar disc herniation.Methods The clinical data of 68 patients who underwent lumbar disc herniation in Taihe Hospital Affiliated to Hubei University of Medicine during April 2010 and April 2011 were collected,and randomly divided into observation group and control group,34 cases in each group.The observation group was treated with small-incision fenestration discectomy,the control group were treated with microendoscopic discectomy.The clinical efficacy of the two groups was observed.Results The VAS and ODI in both groups were reduced significantly after operation(P 0.05) and there were no significant differences between the two groups(P 0.05).The operating time of the observation group was shorter and blood loss was more than those of the control group(P 0.05).Conclusion Microendoscopic discectomy and small-incision fenestration discectomy both have own advantages and disadvantages for lumbar disc herniation with similar therapeutic effect,and the optimal solution can be chosen according to the particular situation.
Discectomy
Fenestration
Lumbar disc herniation
Therapeutic effect
Clinical efficacy
Disc herniation
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As one of the effective treatment methods for lumbar disc herniation,satisfactory effects can be obtained in most patients after discectomy.But some patients still have remaining nerve symptoms, thus influence the curative outcome.This article reviewed the advances in causes and preventions of remai- ning nerve symptoms after discectomy for lumbar disc herniation according to the achievements made by clinical researohers scientists in recent years.
Discectomy
Lumbar disc herniation
Disc herniation
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Microendosopic discectomy (MED) is a minimally-invasive operative therapy for lumbar disc herniation. The purpose of this study is to review our clinical results and the problems of MED. We have obtained good cosmetic results by this method and reduced pain in early postoperative days. Patients are usually very satisfied with the results of MED because it dose not cause severe complications in short and mid-clinical term. However there is still room for improving our skills and the MED system to expand indications and obtain a good field of vision. Despite certain limits of indications, it way be possible to switch the operative method safely for lumbar disc herniation from conventional LOVE method to MED in certain cases.
Lumbar disc herniation
Discectomy
Disc herniation
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Objective To investigate the clinical application of the microendoscopic discectomy in the lumbar disc herniation patients.Methods The clinical data were reviewed in 54 lumbar disc herniation cases who had undergone posterior the microendoscopic discectomy.45 cases were operated upon fenestration decompression procedure,nucleus pulposus extirpation and enlargement of the neural canal by the microendoscopic discectomy.Results Following up 6 months to 12 months.The evaluation with Macnab scale revealed excellent result in 40 cases,good in 6 cases,fairly good in 4 cases,the rate of good results was 92.6%.Conclusion This method is suitable for the treatment of lumbar disc herniation or with light lateral recess stenosis or neural canal stenosis.It has the advantage of good therapeutic effect in short-term and minimal invasion,quick recovery and so on.
Lumbar disc herniation
Discectomy
Lateral recess
Fenestration
Disc herniation
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Objective To investigate the operative procedures and its efficacy of the calcified lumbar disc herniations using microendoscopic discectomy(MED).Methods 67 cases of calcified lumbar disc herniations were performed by MED.The nucleus pulposus was extirpatied,The lateral recess stenosis and the nerve root canal were enlarged.Results With an average of 15 months follow up,50 patients were evaluated using Nakano's criteria.The results were classified as excellent in 37 cases,good in 9 cases and poor in 4 cases.Conclusions MED is a minimal invasive surgical procedure for the calcified lumbar disc herniation.Its small incision can decrease operative blood loss and reduce postoperative pain.Experienced operative skills of MED are the keys to successful treatment.
Lateral recess
Lumbar disc herniation
Discectomy
Disc herniation
Intervertebral Disc Displacement
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Objective: To study the operative tactics and preventing or handling methods for complication of the microendoscopy discectomy in the treatment of lumbar disc herniation. Methods: 22 cases with treatment of microendoscopy discectomy in lumbar disc herniation were analyzed at follow - up. Single disc herniation were in 10 cases,postlateral disc herniation in 18 cases. Centerlateral disc herniation in 4 cases. Results: All of cases were followed up 3 to 10 months,average 6.5 months,The injury of dural was in 2 cases in operation,1 were injured spinal nerve. The good rate was 86.36% . Conclusion:The advantage of microendoscopy discectomy was minimal invasion, no influence on the stability of spine, high distinguishing - rate, adequate decompression of the nerve root and rapid recovery, the suitable indication and precise surgical technique are the key point for this operation.
Discectomy
Lumbar disc herniation
Disc herniation
Diskectomy
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Objective: To investigate the indication and the advantage of microendoscopic discectomy for treatment of the lumbar disc herniation. Methods: 122 cases (137 discs) of lumbar disc herniation were operated by removing the nucleus and amplified lateral recess with MED. Results: 122 cases were followed up for 1.5-13 months. The results were excellent in 87 cases , good in 32 cases and poor in 3 cases according to Machab grades. Conclusion: The MED had advantages of minitrauma, early recovery and excellent efficacy, which could be used to treat most of lumbar disc herniation and lateral recess stenosis. The suitable indication and precise surgical technique were key point for this operation.
Lumbar disc herniation
Lateral recess
Discectomy
Disc herniation
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Objective To explore the safety and efficacy of collagenase injection into vertebral lateral recess for the lumbar disc herniation(LDH).Methods Eighty six cases with LDH were enrolled in this study.46 were with left part herniation,36 cases with right part herniation,and 4 cases with bilateral herniation.45 cases were with L4-5 intervertebral disc herniation,39 cases with L5-S1 disc herniation,2 cases with L4-5 and L5-S1 double disc herniation.The lumbar vertebral lateral recess was punctured through ipsilateral inner margin of small joint guided by C-arm X-ray machine and epidural angiography.After a negative lumbar spinal anesthesia,the collagenase 1200 U(2 ml) was injected into the lumbar vertebral lateral recess.Results All of the patients were without the adverse reaction.Dissolve nuclear symptoms and physical signs were obviously improved in 2 weeks.The excellent and good rate was 80.2% in two weeks and 88.5% in one year,respectively;the effectively rate was 96.5% in two weeks and 96.2% one year,respectively.Conclusion The lumbar spinal epidural lateral recess puncture,with a accurate and individualized dot,angiography and injection of collagen enzyme is a safe and reliable curative method for the LDH.It is easy to be generalized.
Lumbar disc herniation
Lateral recess
Disc herniation
Intervertebral Disc
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Objective:To analyze the clinical effect of small incision fenestration pulposus discectomy for lumbar disc herniation. Method:40 cases of lumbar in our hospital in 2011 April to 2013 April were disc herniation patients as the research object, and randomly divided into two groups, each of 20 cases, the control group underwent conventional operation treatment, the patients in the experimental group received small incision fenestration discectomy treatment, carries on the contrast analysis to the situation and the treatment the operation effect of the two groups.Result:8 cases of the experimental group one(40%), good in 8 cases(40%),the excellent and good rate was 80%; the control group was excellent in 4 cases(20%), good in 8 cases(40%), the excellent and good rate was 60%, there was significant difference between two groups(P0.05).In addition,the two groups had statistical significance of operative time, intraoperative bleeding volume and time of lying in bed in the differences(P0.05).Conclusion:Compared with conventional surgery,small incision fenestration discectomy with little trauma, short operation time, rapid postoperative recovery characteristics, can be used as the main means of the treatment of lumbar disc herniation.
Discectomy
Fenestration
Lumbar disc herniation
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Objective To evaluate the medium and long-term efficacy of operation on lumbar disc herniation with lateral recess stenosis.Methods Eighty-six patients,who underwent the operation from October 1998 to December 2005,were followed-up from 60-142 months(average 161 months).Results The evaluation with Nakai scale revealed excellent in 69 cases(80.2%),good in 13(15.1%),fair in 4(4.7%).Conclusion The medium and long-term outcome of the operation,which solved two problems of lumbar disc herniation and lateral recess stenosis simultaneously,was favorable To prevent nerve root adhesion and strength lumbar muscle practice.
Lateral recess
Lumbar disc herniation
Medium term
Disc herniation
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