Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on...Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.展开更多
Objective:Objective to explore the curative effect of transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:From October 2018 to October 2020,36 patients with lumbar disc herniation were...Objective:Objective to explore the curative effect of transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:From October 2018 to October 2020,36 patients with lumbar disc herniation were randomly divided into group A and group B.the curative effect,pain,lumbar function and quality of life were analyzed.Results:The curative effect of group A was 94.44%,better than that of group B 61.11%,P<0.05;The visual analogue scale(VAS)of group A was lower than that of group B on 3D,5D and 7d after operation(P<0.05);The KSS of group A was higher than that of group B(P<0.05);The score of quality of life in group A was better than that in group B(P<0.05).Conclusion:Lumbar disc herniation patients underwent transforaminal endoscopic surgery,the effect is good,can improve lumbar function,relieve pain,improve the quality of life of patients.展开更多
Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervert...Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.展开更多
文摘Lumbar Disc Herniation and Lumbar Spine Stenosis are the most common spine diseases which are mainly due to age related Spine degeneration. Diagnosis of both Lumbar Disc Herniation and Lumbar Spine Stenosis depends on clinical findings as well as radiological investigations. Treatment of choice of these conditions is on the basis of the patient conditions. Surgical treatment is the option only when the conservative treatment does not improve the patient’s clinical condition. Advancement and improvement of the technology have resulted in the traditional open surgical treatment into minimal invasive surgery. Intervention of the different surgical instruments with expert spinal surgeons had made percutaneous endoscopic lumbar Spine surgery as one of the preferred choices of surgery for treating Lumbar Disc Herniation and Lumbar Spine Stenosis. The concept of percutaneous endoscopic surgery for lumbar region is to provide surgical options without producing iatrogenic morbidity associated with the open surgical procedures. Conventionally, there are different approaches/techniques for Percutaneous Endoscopic Lumbar Spine Surgery, but in this review we are mainly focusing on the Transforaminal Technique. Regarding the Lumbar Disc Herniation treatment with transforaminal approach, a number of articles have been published due to which we mainly focused on those articles which were published after 2009 onwards. While fewer articles related to Lumbar Spine Stenosis treatment with Transforaminal approach were found, we tried to brief out all those articles. On the basis of comparative study of different surgeries done for Lumbar Disc Herniation and Lumbar Spine Stenosis, Percutaneous Transforaminal endoscopic Lumbar Surgery provides a substantial benefit. Transforaminal approach for treating Lumbar Disc Herniation and Lumbar Spine Stenosis is safe and effective. The Percutaneous Transforaminal Endoscopic Lumbar Surgery has advantage as it is performed under local anesthesia with shorter length of hospitalization and early return to normal life. The clinical outcome of the patient that underwent Percutaneous Transforaminal Endoscopic Lumbar Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis is quite good in regard of its fewer complication and more benefits.
文摘Objective:Objective to explore the curative effect of transforaminal endoscopic surgery in the treatment of lumbar disc herniation.Methods:From October 2018 to October 2020,36 patients with lumbar disc herniation were randomly divided into group A and group B.the curative effect,pain,lumbar function and quality of life were analyzed.Results:The curative effect of group A was 94.44%,better than that of group B 61.11%,P<0.05;The visual analogue scale(VAS)of group A was lower than that of group B on 3D,5D and 7d after operation(P<0.05);The KSS of group A was higher than that of group B(P<0.05);The score of quality of life in group A was better than that in group B(P<0.05).Conclusion:Lumbar disc herniation patients underwent transforaminal endoscopic surgery,the effect is good,can improve lumbar function,relieve pain,improve the quality of life of patients.
基金Anhui Province from Cong Qingwu Old Chinese Medicine Studio Project.Project No:2100601.
文摘Objective:To investigate the early efficacy of two approaches for lumbar disc herniation under spinal endoscopy.Methods:45 cases of lumbar disc herniation were divided into interlaminar approach(27 cases)and intervertebral foramen approach(18 cases)according to different surgical approaches.Postoperative pain visual analogue scale(VAS)was used.Japanese Orthopaedic Association(JOA)lumbar spine score(JOA)and modified Macnab criteria were used to evaluate the postoperative outcome.Results:(1)VAS score.There is no interaction effect between the access mode and the time factor(F=0.620,P=0.603).There were statistically significant differences in pain VAS scores between preoperative and postoperative time points,that is,there was a time effect(F=2157.488,P=0.000).The overall VAS scores of the two groups were compared,and the difference was not statistically significant,that is,there was no grouping effect(F=2.610,P=0.114).The VAS score of pain in both groups decreased with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);JOA score.There is no interaction effect between the access mode and the time factor(F=1.296,P=0.280).The difference of JOA score between preoperative and postoperative time points was statistically significant,that is,there was a time effect(F=1464.830,P=0.000).JOA scores of the two groups showed an increasing trend with time,and the differences between the two groups were not statistically significant before surgery,at discharge,1 month after surgery and 3 months after surgery(t=0.067,P=0.947;t=1.415,P=0.164;t=0.564,P=0.575;t=0.442,P=0.660);(2)The improved Macnab standard was used to evaluate the excellent and good rate at 3 months after surgery.In the interlaminar group,12 cases were excellent,13 cases were good and 2 cases were fair.The excellent and good rate was 92.6%.In the intervertebral foramen group,7 cases were excellent,10 cases were good and 1 case was fair.The excellent and good rate was 94.4%.The overall excellent and good rate of the two groups was 93.3%.Conclusion:Both approaches can achieve satisfactory efficacy in the treatment of lumbar intervertebral disc herniation,which is worthy of clinical application.However,for beginners,l5-s1 lumbar disc herniation is more suitable for intervertebral disc approach,so as to achieve satisfactory efficacy.
文摘目的:比较后入路腰椎椎体间融合术(posterior lumbar interbody fusion,PLIF)和经皮内镜下经椎间孔腰椎椎体间融合术(percutaneous endoscopic transforaminal lumbar interbody fusion,PE-TLIF)治疗单节段腰椎管狭窄症的临床疗效及其对椎旁肌的影响。方法:本前瞻性研究纳入本院2019年1月~2022年1月收治的52例L4/5单节段腰椎管狭窄症患者。其中,PLIF组22例,女性10例,男性12例,年龄60.2±10.3岁;PE-TLIF组30例,女性14例,男性16例,年龄60.4±12.3岁。对比两组手术时间、术中出血量、术后引流量、术后卧床时间等围手术期指标;比较术前与术后1d及1周血清肌酸激酶(creatine kinase,CK),术前与术后6个月及12个月多裂肌(multifidus,MF)横截面积(cross-sectional area,CSA)、脂肪浸润(fatty infiltration,FI)评分及肌肉CT密度等椎旁肌评估指标;比较两组患者术前、术后1d、1周、6个月及12个月腰痛视觉模拟评分(visual analogue scale on low back pain,VAS-LBP)、腿痛视觉模拟评分(visual analogue scale on leg pain,VAS-LP)、Oswestry功能障碍指数(Oswestry disability index,ODI)。对两组术后并发症发生情况进行比较,术后12个月根据Bridwell标准评估两组椎间融合情况。结果:PE-TLIF组与PLIF组手术时间(211.2±38.5min vs 98.9±31.6min,P=0.000)、术后卧床时间(25.9±8.3h vs 52.4±14.8h,P=0.001)、术中失血量(112.8±79.6mL vs 232.5±122.5mL,P=0.002)、术后引流量(46.5±28.2mL vs 283.6±142.1mL,P=0.000)相比,差异均具有统计学意义。PE-TLIF组与PLIF组术前、术后6个月及12个月目标节段MF CSA组间比较均无明显差异(P>0.05),两组术前与术后6个月及12个月的目标节段MF CSA组内比较无明显差异(P>0.05)。PE-TLIF组与PLIF组术前、术后6个月目标节段MF FI评分组间比较无统计学差异(P>0.05),术后12个月,PLIF组目标节段MF FI评分较PE-TLIF组高,差异具有统计学意义[3.0(3.0,4.0)vs 3.0(2.8,3.0),P=0.031];PE-TLIF组术前与术后6个月、12个月目标节段MF FI评分组内比较无明显差异(P>0.05),PLIF组术前与术后6个月目标节段MF FI评分组内比较未发现明显差异(P=0.257),而术前与术后12个月比较,差异具有统计学意义[3.0(2.0,3.3)vs 3.0(3.0,4.0),P=0.016]。术前、术后6个月两组患者MF CT密度相比较无明显差异(P>0.05)。术后12个月,PLIF组目标节段MF密度明显降低,差异具有统计学意义[PE-TLIF:34.2(31.8,36.9)HU;PLIF:30.5(28.5,32.1)HU,P=0.000]。组内比较,PE-TLIF组术前与术后6个月、12个月目标节段MF肌肉密度比较差异无显著统计学意义(P>0.05)。PLIF组术前与术后6个月目标节段MF CT密度比较,未发现明显差异(P=0.516),术后12个月较术前明显升高,差异具有统计学意义[34.6(30.5,36.4)HU vs 30.5(28.5,32.5)HU,P=0.017]。PE-TLIF组与PLIF组术前CK值无明显差异(P=0.712)。术后1d、7d,PE-TLIF组CK值低于PLIF组(P<0.05)。PE-TLIF组与PLIF组患者术后随访VAS-LP、VAS-LBP评分以及ODI均优于术前,差异具有统计学意义(P<0.05)。术后1d、7d,PE-TLIF组VAS-LBP评分表现优于PLIF组(P<0.05)。术后6个月、12个月,两组患者的VAS-LBP评分比较无明显差异(P>0.05)。两组患者的VAS-LP评分以及ODI在随访时无明显差异(P>0.05)。两组患者术后并发症发生率比较无统计学差异(P=0.379),术后12个月两组患者椎间融合情况比较无统计学差异(P=0.877)。结论:PE-TLIF治疗单节段腰椎管狭窄症可获得与传统PLIF手术相同的临床疗效,且减小了对椎旁肌的影响,可减轻手术创伤。
