[Clinical effect of minimally-Invasive surgical-transforaminal lumbar interbody fusion technique associated with percutaneous pedicle screws in micro endoscopy discectomy].
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Objective: To evaluate the clinical efficacy between the minimally-Invasive surgical (MIS)-transforaminal lumbar interbody fusion (TLIF) technique associated with percutaneous pedicle screws in micro endoscopy discectomyand MIS-TLIF technique associated with both sides of the lower lumbar spine Wiltse approach in Quadrant channel with treatment of single segment herniation associated with lumbar instability syndrome. Methods: From January 2012 to January 2015, 75 cases that meet the inclusion and exclusion criteria were treated by retrospective study method, which were divided into two groups in Department of Orthopedics, the Affiliated Hospital of Putian University.Experimental group(30 patients) were treated with MIS-TLIF technique associated with percutaneous pedicle screws in microendoscopy discectomy, control group were treated with MIS-TLIF technique associated with both sides of the lower lumbar spine Wiltse approach in Quadrant Chanel.Compare operation time, blood loss, postoperativehospital stay, clinical efficacy, nailing accuracy, fusion rate, postoperative pain scoring of two groups. Results: The blood loss[(102.1±5.5) min vs(103.7±7.7) min, t=-0.586, P>0.05], postoperative blood loss, hospital stay[(44.6±5.2) ml and(57.2±5.3) ml, (7.3±1.6) d and(9.3±1.9) d; t=-5.813, -2.774, P<0.05], JOA score before and after surgery in same group were statistically significant(P<0.05), respectively.Patients of two groups compared with operation time, clinical efficacy, nailing accuracy[group A: 97.5%, group B: 95.7%; χ(2)=3.00, P>0.05.Postoperative 3 month , group A: 96.7%(29/30), group B: 94.3%(33/35; χ(2)=0.79, P>0.05], fusion rate[group A: 96.7%(29/30), group B: 94.3%(33/35), χ(2)=0.79, P>0.05], preoperative JOA score[(20.4±2.4)score and(7.9±1.0), (19.1±2.7)score and(7.8±1.2)score], postoperative JOA score were no statistically significant respectively, P>0.05. JOA score of both groups were statistically significant respectively Before and after operate.Excellent rate: group A; 84.4%(25/30), group B: 80.0%(28/35), χ(2)=0.43, P>0.05. Conclusion: MIS-TLIF technique associated with percutaneous pedicle screws in micro endoscopy discectomy relative to conventional minimally invasive spine surgery had many advantages: minimal damage, operation conveniently, precisely clinical effect, that is a kind of feasible and reliable minimally invasive surgery which is worth promoting.目的：探讨显微内窥镜(MED)下经皮椎弓根螺钉微创经椎间孔入路椎间融合术(MIS-TLIF)治疗单节段腰椎间盘突出伴腰椎不稳症的临床疗效。 方法：将2012年1月至2015年1月莆田学院附属医院微创脊柱外科收治的经X线片、CT和MRI检查等明确诊断为单节段腰椎间盘突出伴腰椎不稳症，无严重器官功能障碍或系统性疾病的患者65例。30例患者纳入A组，采用MED下髓核摘除＋椎间植骨融合＋经皮椎弓根螺钉内固定治疗。35例患者纳入B组，采用Quadrant通道下腰椎双侧Wiltse入路MIS-TLIF术。比较两组患者手术时间、出血量、术后住院时间、置钉准确性、融合率、术前术后疼痛评分、临床疗效。 结果： A组和B组手术时间分别为(102.1±5.5) min和(103.7±7.7) min(t＝-0.586，P>0.05)；A组和B组术中出血量、术后住院时间分别为(44.6±5.2) ml和(57.2±5.3) ml，(7.3±1.6) d和(9.3±1.9) d(t分别为-5.813、-2.774，均P<0.05)。A组植入120颗椎弓根螺钉，B组植入140颗椎弓根螺钉，A组优良率为97.5%，B组优良率为95.7%(χ(2)＝3.00，P>0.05)。A组术后3个月融合率为96.7%(29/30)，B组术后3个月融合率为94.3%(33/35)(χ(2)＝0.79，P>0.05)。A组和B组术前、术后3个月日本骨科协会评估治疗评分(JOA)分别为(20.4±2.4)分和(7.9±1.0)、(19.1±2.7)分和(7.8±1.2)分；A组、B组术前JOA评分相比，术后JOA评分相比，差异无统计学意义(t分别为1.242、0.178，均P>0.05)；A组术前、术后JOA评分；B组术前、术后JOA评分差异有统计学意义(P<0.05)。两组患者术后临床疗效优良率A组为84.4%(25/30)，B组为80.0%(28/35)，差异无统计学意义(χ(2)＝0.43，P>0.05)。 结论： MED下经皮螺钉MISS-TLIF术为相对常规脊柱微创手术，创伤小，操作便捷，临床疗效确切，是一种可行、可靠的微创手术方式，值得推广。.Keywords:
Quadrant (abdomen)
Discectomy
Lumbar disc herniation
Objective To investigate the mid-term outcome and complications of percutaneous lumbar disecectomy for lumbar herniated disk.Methods 83 patients with lumbar herniated disk were performed with percutaneous lumbar discectomy.The patients were followed up and the outcomes were evaluated with MacNab criteria.Results A total of 83 patients in 6 months after PLD and 78 patients in 3 years after PLD were eligible for analyses,with a follow-up period of 3 years.According to the MacNab criteria,92% patients in 6 months after PLD and 86.7% patients in 3 years after PLD achieved excellent or good results.Local hematoma in puncture site was found in 2 patients.Back pain were found in 3 patients.Conclusion Percutaneous lumbar discectomy is an effective,safe and less complications option for lumbar herniated disk.The mid-term results of PLD is promising.
Intervertebral disk
Discectomy
Diskectomy
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Objective:To evaluate the surgical treatment of percutaneous lumbar discectomy for far lateral lumbar disc herniation clinical effects.Methods:C-arm X-ray machine guided percutaneous lumbar disc puncture,ring sawing drilling through the catheter discectomy.Treatment of single segment of extreme lateral lumbar disc herniation in 15 cases,of which eight cases of foramina area,foramina Outer Waters District 7 cases;10 males and 5 females,aged from 31 to 75 years with an average age of 51 years.Results:The operative time was 50～120min,an average of 66min;bleeding 50～120mL,an average of 80mL;the average length of stay is 5 days.Follow-up period of 1 to 3 years,according to Macnab criteria evaluation,were excellent in 9 cases,good in 4 cases,1 case and poor in 1 case,the fine rate was 86.7%.Conclusions:Percutaneous lumbar discectomy treatment of extreme lateral lumbar disc herniation with a little injury,safety,efficacy significantly faster recovery and so on.
Lumbar disc herniation
Discectomy
Lateral recess
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Intervertebral disk
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[Objective] To explore the methods,and effect of transforaminal lumbar interbody fusion for lumbar vertebral degenerative instability and degenerative disc disease with herniated nucleus pulposus by microendoscopic surgery. [Methods] 21 cases who underwent transforaminal lumbar interbody fusion by microendoscopic surgery were analyzed retrospectively. [Results] 21 cases were reviewed after surgery. The postoperative follow-up ranged from 12 months to 24 months. No cases converted to open operation. Operative time averaged 150 minutes. Estimated blood loss averaged 120 mL. Mean length of hospital stay was 8 days. There were no nerve injury occurred during operation.In complications,one case suffered from intervertebral infection. Outcomes were quantified using Oswestry Disability Index. The average Oswestry score decreased from 48.3% preoperatively to 16.5% at 3 month and 14 at 6 month postoperatively. The rate of excellent and good was 97.0%. At last follow-up, all patients had solid fusions by radiographic criteria. [Conclusions] Transforaminal lumbar interbody fusion for lumbar vertebral degenerative instability by microendoscopic surgery has the advantages of shorter skin incision, less tissue damage, less blood loss and quicker postoperative recovery.
Oswestry Disability Index
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Objective . The goal of the present study was to examine the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar surgery for patients with adjacent segment degeneration (ASD) and recurrence of disc herniation. Methods . From December 2011 to November 2013, we collected forty-three patients who underwent repeated lumbar surgery. These patients, either received PELD (18 patients) or repeated open lumbar surgery (25 patients), due to ASD or recurrence of disc herniation at L3-4, L4-5, or L5-S1 level, were assigned to different groups according to the surgical approaches. Clinical data were assessed and compared. Results . Mean blood loss was significantly less in the PELD group as compared to the open lumbar surgery groupP < 0.0001 P < 0.0001 P < 0.0001
Lumbar disc herniation
Discectomy
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Objective To evaluate the clinical effect of minimally invasive transmultifidus approach by the Quadrant system for lumbar degenerative disease.Methods From Jan 2010 to Mar 2012,72 patients with lumbar degenerative diseases were divided into two groups and underwent different types of transforaminal lumbar interbody fusion surgery.Mininmally invasive TLIF(MIS-TLIF)group(33 cases)received minimally invasive treatment with DePuy Viper 1 system combined endoscopically assisted TLIF.Open TLIF group(39 cases) underwent traditional open TLIF surgery.The length of the cut,the blood loss,operation time and effect were observed and compared between the two groups.Results All cases had been followed up between 12-18 months,average of 15 months.There was no significant differences in operation time between the groups(P0.05).Surgical blood loss,surgical draining loss,hospital stay,analgesics use and dose(P0.01) were less in MIS-TLIFgroup.The scores of VAS and ODI in MIS-TLIDF group were less than those in Open TLIF group(P0.01).Conclusion The application of Quadrant system in Surgical treatment of lumbar degeneration,which has less injury,less blood loss,less hospital stay,and satisfied function recovery,is an effective minimally invasive surgical method.
Quadrant (abdomen)
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To explore the clinical effects of PLIF surgery for elderly patients with lumbar degenerative disease.From March 2010 to May 2013, 28 patients with lumbar degenerative disease, aged more than 80 years were treated with PLIF surgery. There were 10 males and 18 females, aged from 80 to 93 years old with an average of (85.44±3.66) years. Course of disease was from 3 to 20 years. The operation time, intra-operative blood loss, operation complications were recorded and JOA scores and Macnab criteria were used to evaluate the clinical outcomes.All patients were followed up from 12 to 40 months with an average of 26.5 months. The average operation time was (150.00±26.42) min and the average intra-operative blood loss was (373.33±99.88) ml. The pre-operative JOA score was 12.30±2.43, and the corresponding postoperative JOA score at the final follow-up was 24.81±2.09 which was much higher than the preoperative one (P<0.01). According to the modified Macnab criteria to evaluate at the final follow-up, 16 patients got an excellent result, 10 good, 2 fair. In the weeks postoperatively, injuries of nerve root happened in 3 cases, superficial wound infection with delayed healing in 3 cases, and tear of the dural sac accompanied with cerebrospinal fluid leakage in 1 case. After long term follow-up, adjacent segment degeneration and the corresponding spinal canal stenosis occurred in 1 case at 34 months after operation. All cases got successful fusion without any displacement of internal fixation and pseudoarthrosis formation.With proper cases, fully preoperative preparation, perfect intra-operative manipulation and active treatment after operation, even advanced ages older than 80 years with lumbar degenerative disease could get satisfactory outcomes after PLIF surgery.
Spinal disease
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Objective To evaluate the clinical efficacy differences of anterior and posterior debridement in the treatment of lumbar vertebral tuberculosis and provide useful basis for clinical treatment.Methods 62 patients with lumbar vertebral tuberculosis were randomly divided into the anterior group(31 cases) and the posterior group(31 casess).The elective debridement and grafting fusion and internal fixation surgery was performed.The surgery time,amount of blood loss,length of hospital stay,ESR,cobb angle,bone fusion and postoperative recurrence and other conditions 1 month and 3 months after surgery of the two groups were compared.Results The amount of blood loss,ESR 3 months after surgery,and cobb angle and number of recurrence 12 months after surgery of the anterior group were superior to the posterior group,differences were all statistically significant(all P 0.05).Conclusion There are corresponding indications in the anterior and posterior clinical treatment of lumbar vertebral tuberculosis,but the anterior debridement,compared with the posterior debridement,has less blood loss,smaller correction angel loss,faster grafting fusion,lower recurrence rate and other characteristics,and therefore has better clinical efficacy.
Debridement (dental)
Cobb angle
Bone grafting
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Discectomy
Lumbar disc herniation
Intervertebral disk
Intervertebral Disc
Intervertebral Disc Displacement
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To investigate the feasibility and the mid-term effects of unilateral pedicle screw fixation and transforaminal lumbar interbody fusion in treating lumbar degenerative diseases.From August 2005 to May 2010, 56 patients with lumbar degenerative diseases underwent lumbar posterolateral fusion,their clinical data were retrospective analyzed. The patients were divided into two groups (unilateral group and bilateral group) according to fixation methods,27 patients in unilateral group who were underwent unilateral pedicle screw fixation, including 18 males and 9 females with a mean age of (57.5 ± 7.1) years old (ranged from 41 to 66 years); and 29 patients in bilateral group who were treated with bilateral pedicle screw fixation (on the basis of the above, with contralateral vertebral pedicle screw fixation), including 19 males and 10 females with a mean age of (54.6 ± 5.1) years old (ranged from 43 to 68 years). The clinical data such as operation time, blood loss volume, hospitalization time and cost were compared between two groups. JOA score system was used to evaluate the neurological function. And fusion status and cage-related complication were also analyzed.All patients were followed up from 36 to 60 months with an average of 45.8 months. No iatrogenic nerve, blood vessels or organs injury were found during operation. Operation time, blood loss volume, hospitalization time and cost in unilateral group were better than that of bilateral group (P < 0.05). There was no significant difference in JOA score between two groups (P > 0.05). Two patients in unilateral group developed with cage related complications, 1 case was cage displacement and 1 case was cage subsidence, while 2 patients in bilateral group developed with complications of no-fusion, and there was no significant differences between two groups (P = 0.58).Unilateral pedicle screw fixation is a satisfactory method and can obtain good effects in treating lumbar degenerative diseases in mid-term, however, the indications should be well considered.
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