Application Research of PETD Combined with MRI Nerve Root Water Imaging in the Minimally Invasive Treatment of LDH

Objective: This study aims to evaluate the safety and efficacy of PETD combined with nerve root water imaging of MRI for the treatment of lumbar disc herniation. Methods: A retrospective review was performed on 62 patients with lumbar disc herniation from March 2019 to March 2021. The study included an experimental group of 30 patients and a control group of 32 patients. The experimental group underwent PETD combined with nerve root water imaging of MRI, while the control group received traditional PETD treatment. The visual analogue scoring method (VAS score), and JOA lumbar spine function score before and after surgery were compared between the two groups, and efficacy was assessed and compared using the MacNab score. Results: The mean operation time was significantly reduced in the experimental group (56.43 ±10.40 minutes) compared to the control group (65.69 ±14.12 minutes). The VAS score was compared between the two groups with preoperative (p = 0.624), one month after surgery (p = 0.325), three months after surgery (p = 0.676), one year after surgery (p = 0.341);The JOA score was compared between the two groups with preoperative (p = 0.961), one month after the surgery (p = 0.266), three months after surgery (p = 0.185), one year after surgery (p = 0.870), they were no significant statistical difference;The efficacy evaluation of the last follow-up Macnab showed that all the 30 patients in the experimental group were excellent, 31 of 32 patients in the control group were excellent, 1 case was good;There was no statistical difference in the comparison between the two groups (p > 0.05). Conclusion: The study concludes that the combined approach of PETD with nerve root water imaging of MRI is a safe, effective, and more efficient alternative to conventional PETD for treating lumbar disc herniation.

椎间孔镜下腰椎间盘髓核摘除术治疗腰椎间盘突出症并发症的临床分析

随着脊柱微创技术的不断发展,经皮椎间孔镜技术在腰椎间盘突出症治疗方面得到了大量应用,并取得了较好的临床效果。一般认为经皮椎间孔镜下腰椎间盘髓核摘除术（percutaneous endoscopic lumbar discectomy,PELD）治疗腰椎间盘突出症创伤小,安全有效,术后康复快,但是对于其手术相关并发症的研究较少。

经皮脊柱内镜椎板间入路治疗腰椎间盘突出症的进展

腰椎间盘突出症（Lumbar disc herniation,LDH）是临床常见病,大部分可由保守治疗而治愈,但仍有10%~20%的患者需要手术治疗。常规开放性椎间盘摘除术仍然是治疗腰椎间盘突出症的标准方法,但脊柱结构损伤和有症状的硬膜外瘢痕在开放性手术的发生率超过10%,并且存在创伤大、恢复时间长、复发率高、后瘢痕粘连及背部手术失败综合征等缺点。

脊柱内镜技术的历史、现状与发展

近年来,经皮脊柱内镜下腰椎间盘摘除术（Percutaneous endoscopic lumbar discectomy,PELD）的临床应用已取得了丰硕的成果。随着脊柱内镜技术及相应技术的迅速发展,该技术也在传统开放手术领域中获得了成功的应用,脊柱内镜技术已逐步进入一个崭新的时代。在微创脊柱外科技术蓬勃发展的今天,正确认识脊柱内镜技术,掌握适应证和熟练的操作技巧是取得良好疗效的关键。

学习曲线及其在微创脊柱外科的意义

伴随微创理念的创新和医学思维模式的进步,为了减少手术入路中的组织损伤、维持身体内环境稳定的同时获得良好的疗效,脊柱外科医生开始涉足更多的手术方法。随着光纤、内窥镜、可视成像及微创设备的发展,在过去20年里微创脊柱外科发展迅速,各种脊柱微创术式相继出现,新技术的＂学习曲线＂应运而生。如何正确认识微创脊柱外科中的学习曲线已成为当代外科临床研究的焦点。

椎间孔镜手术术中导丝断裂并发症1例报道

经皮内窥镜下腰椎间盘摘除即椎间孔镜（percutaneous endoscopic lumbar discectomy,PELD）作为一种常见的脊柱微创手术方法,已广泛应用于腰椎间盘突出症等多种疾病的治疗,Kambin描述了PELD手术的适应证：伴有或者不伴有神经损害;顽固性疼痛保守治疗8周无效;疼痛具有典型的神经根症状[1]。由此可见,适合传统腰椎间盘手术的标准也适合PELD。

骶管阻滞术联合牛痘疫苗接种家免炎症皮肤提取物治疗透皮椎间孔镜术后腰腿痛及麻木的临床观察

随着微创技术日新月异的发展,透皮椎间孔镜下髓核摘除术（percutaneous endoscopic lumbar discectomy,PELD）已被广泛用于治疗腰椎间盘突出症,因其具有手术切口小、对脊柱及周围结构损伤小、术后卧床时间短及恢复较快等特点,被认为是目前最微创和最具发展潜力的脊柱内镜技术,也越来越受到医护工作者和患者的认同和接受。但也有患者PELD术后出现腰腿痛及麻木等症状,

颈前路减压融合术中切除后纵韧带的方法改进

颈椎前路椎间盘切除减压融合术（anterior cervical discectomy and fusion,ACDF）在术中是否切除颈椎后纵韧带（posterior longitudinal ligament,PLL）还存在很多争议[1]。综合文献结果,多数认为术中切除颈椎PLL可以取得更确实、充分的减压,术后患者神经功能获得更好的改善[2~5]。

经皮内窥镜下腰椎间盘髓核摘除术的现状与展望

经皮内窥镜下腰椎间盘髓核摘除术（percutane-ous endoscopic lumbar discectomy,PELD）是治疗腰椎间盘突出症安全有效的新型手术方式。与传统的开放手术方式相比,该方法除了能达到相似的手术效果外,还具有微创、患者痛苦小、恢复快等优点,以经Kambin安全三角区进入椎间盘内行椎间盘内减压以达到神经根间接减压的YESS（Yeung endoscop-ic spine system）技术[1],

不稳定抗阻训练对肌肉活性的影响

不稳定抗阻训练(instability resistance train-ing,IRT)是指在不稳定的平面或者使用能够为训练提供不稳定因素的设备,利用自身重力或者外部负荷进行抗阻训练的一种方法[1]。瑞士球、博苏球等各种球类以及泡沫轴、悬吊系统、沙子、水等都可以提供不稳定平面,此外还可以通过单侧身体的负重以及改变身体与地面的接触面积实现不稳定抗阻训练。早在第二次世界大战之前。

关于微创技术在颈椎前路手术中应用的若干思考

20世纪80年代以来,以显微内窥镜下椎间盘切除术（microendoscopic discectomy,MED）为代表的脊柱外科微创手术（minimally invasive spine surgery,MISS）发展迅速[1]。当前经皮（percutaneous）、内窥镜（endoscopic）和通道（minimal access）技术是临床上常用的3种微创手术方式,应用领域也从早期的胸腰椎拓展至颈椎[2]。

Transforaminal Percutaneous Endoscopic Discectomy using Transforaminal Endoscopic Spine System technique: Pitfalls that a beginner should avoid

Transforaminal Percutaneous Endoscopic Discectomy(TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.

Ultrasound guidance for transforaminal percutaneous endoscopic lumbar discectomy may prevent radiation exposure: A case report

BACKGROUND Percutaneous endoscopic lumbar discectomy(PELD)has become a mature and mainstream minimally invasive surgical technique for treating lumbar disc herniation(LDH).Repeated fluoroscopy,with more than 30 shots on average,is inevitable to ensure its accuracy and safety.However,exposure to X-rays may pose a threat to human health.We herein report a case of ultrasound(US)-assisted PELD in two levels of LDH to explore a new possibility that can reduce the radiation dose during puncture and cannulation in PELD.CASE SUMMARY A 38-year-old man with low back pain and left leg pain for more than 7 years came to our clinic,his symptoms had aggravated for 1 month,and he was diagnosed with L3-4 and L4-5 disc herniations.He received US-guided PELD with good results:His straight leg elevation increased from 40 to 90 degrees after PELD,and his visual analog scale(VAS)and Oswestry Disability Index scores both significantly decreased immediately and 6 mo after PELD.With the guidance of US,he received only two shots of fluoroscopy(fluoroscopic time:4.4 s;radiation dose:3.98 mGy).To our knowledge,this is the first case of US-guided puncture and cannulation of PELD for LDH at two levels.CONCLUSION US could be used to guide PELD and has the potential to largely reduce radiation than traditional X-ray guidance.

Comparison of microendoscopic discectomy and open discectomy for single-segment lumbar disc herniation

BACKGROUND Lumbar disc herniation is a common disease.Endoscopic treatment may have more advantages than traditional surgery.AIM To compare the clinical efficacy and safety of microendoscopic discectomy(MED)and open discectomy with lamina nucleus enucleation in the treatment of singlesegment lumbar intervertebral disc herniation.METHODS Ninety-six patients who were operated at our hospital were selected for this study.Patients with single-segment lumbar disc herniation were admitted to the hospital from March 2018 to March 2019 and were randomly divided into the observation group and the control group with 48 cases in each group.The former group underwent lumbar discectomy and the latter underwent laparotomy and nucleus pulpectomy.Surgical effects were compared between the two groups.RESULTS In terms of surgical indicators,the observation group had a longer operation time,shorter postoperative bedtime and hospital stay,less intraoperative blood loss,and smaller incision length than the control group(P<0.05).The excellent recovery rate did not differ significantly between the observation group(93.75%)and the control group(91.67%).Visual analogue scale pain scores were significantly lower in the observation group than in the control group at 1 d,3 d,1 mo,and 6 mo after surgery(P<0.05).The incidence of complications was significantly lower in the observation group than in the control group(6.25%vs 22.92%,P<0.05).CONCLUSION Both MED and open discectomy can effectively improve single-segment lumbar disc herniation,but MED is associated with less trauma,less bleeding,and a lower incidence of complications.

经皮内镜下腰椎间盘髓核切除术的应用进展

开放手术治疗腰椎间盘突出症创伤大、恢复慢、费用高,随着新技术及新材料的发展,在保证/提高疗效的前提下,先后出现经皮椎间盘切吸术、经皮激光汽化椎间盘减压术、经皮低温等离子射频消融髓核成形术、臭氧髓核消融术、胶原酶溶解术、显微内镜椎间盘切除术（micro endoscopic discectomy,MED）等,但以上方法适应证窄,疗效不确定,临床应用不广泛。

Technique of Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.

两种介入方法治疗椎间盘源性颈痛的疗效比较

在引起反复发作的慢性颈痛原因中,椎间盘源性颈痛（discogenic neck pain,DNP）仅次于颈椎间盘突出症（cervical disc herniation,CDH）列于第二位。尽管经皮低温等离子射频靶点热凝术及射频消融术治疗CDH已获认可。且亦有文献证实上述两种方法对于DNP的疗效亦较显著,但对于两种方法在DNP治疗中的疗效对比尚无报道。

Surgical Outcome of Fusion in Recurrent Lumbar Disc Herniation

Background Data: Recurrent lumbar disc herniation means re-herniation of disc on the same site and at the same level where a previous discectomy had been performed: recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Tow mean surgical options after reherniated lumbar disc are revision discectomy alone or revision discectomy with fusion discectomy alone in recurrent lumbar disc herniation may not be an efficient treatment without fusion. Objective: To evaluate the efficacy and safety of revision discectomy with fusion in management of recurrent lumbar disc. Study Design: Retrospective study reviewed all patient underwent revision discectomy with fusion, they were 40 patients operated for recurrent lumbar disc from September 2014 to April 2018 in Al-Azhar University Hospital Damietta. Pre- and post-operative data collection and analysis of the outcome were completed based on the “Japanese Orthopedic Association score” (JOAs), and radiographic follow-up. Patients and Methods: 40 patients (30 male and 10 female) underwent revision discectomy with fusion as surgical management for reherniated lumbar disc from September 2014 to April 2018. All patients presented with low back pain and radicular pain with mean duration of 18 months. The patients were investigated by standard plain X-ray CT SCAN and MRI of the lumbar spine. All patients had a discectomy and postero-lateral fusion in revision surgery. These patients followed post operatively clinically for improving pain and neural function, and radiologically for disc removal stability and fusion. Results: The age ranged from 30 to 60 years, mean age was 45 years, male to female ratio 3:1. Follow-up ranged from 18 - 30 months with a mean follow-up 24 months. 30 patients had an excellent outcome, 6 patients had a good outcome, 2 patients had a fair outcome, and 2 patients had a poor outcome. Conclusion: Recurrent lumbar disc herniation occurs in 7% to 24% of patient underwent discectomy. Revision surgery when indicated can be done by various techniques. Revision discectomy with fusion for reherniated lumbar disc is effective and safe with confident results.

Two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniation: A case report

BACKGROUND The technique of percutaneous endoscopic lumbar discectomy(PELD)as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations.However,due to the different anatomic characteristics of the upper lumbar spine,conventional transforaminal PELD may fail to remove the highly migrated upper lumbar disc nucleus pulposus.Therefore,the purpose of this study was to describe a novel surgical technique,two-level PELD,for the treatment of highly migrated upper lumbar disc herniations and to report its related clinical outcomes.CASE SUMMARY A 60-year-old male presented with a complaint of pain at his lower back and right lower limb.The patient received 3 mo of conservative treatments but the symptoms were not alleviated.Physical examination revealed a positive femoral nerve stretch test and a negative straight leg raise test for the right leg,and preoperative visual analog scale(VAS)score for the lower back was 6 points and for the right leg was 8 points.Magnetic resonance imaging(MRI)demonstrated L2-L3 disc herniation on the right side and the herniated nucleus pulposus migrated to the upper margin of L2 vertebral body.According to physical examination and imaging findings,surgery was the primary consideration.Therefore,the patient underwent surgical treatment with two-level PELD.The pain symptom was relieved and the VAS score for back and thigh pain was one point postoperatively.The patient was asymptomatic and follow-up MRI scan 1 year after operation revealed no residual nucleus pulposus.CONCLUSION Two-level PELD as a transforaminal approach can be a safe and effective procedure for highly migrated upper lumbar disc herniation.

Outcomes of cervical degenerative disc disease treated by anterior cervical discectomy and fusion with self-locking fusion cage

BACKGROUND Cervical degenerative disc(CDD)disease is a common type of spondylosis.Although anterior cervical discectomy and fusion(ACDF)is the preferred treatment for CDD disease,internal fixation with a titanium plate may cause various complications.The invention of the ACDF with a self-locking fusion cage(ROI-C)has effectively decreased the incidence of postoperative complications.AIM To observe the outcomes of CDD disease treated by ACDF with a ROI-C.METHODS Ninety patients with CDD disease treated at our hospital from March 2019 to March 2021 were included.They were divided into two groups(control group and observation group,n=45 in each)using a random number table.Patients in the control group received ACDF plus internal fixation with a titanium plate.Those in the observation group received ACDF+ROI-C placement.The two groups of patients were compared in terms of surgical parameters,pain,cervical spine function,range of motion,and complications.RESULTS The two groups of patients showed no significant differences in surgical time,blood loss,drainage volume,and length of hospital stay(P>0.05).No significant differences in the visual analogue scale(VAS),Japanese Orthopedic Association(JOA),and neck disability index(NDI)scores were observed between the two groups before surgery(P>0.05).The VAS and NDI scores in the observation group were considerably lower than those in the control group after surgery;however,the JOA scores in the observation group were significantly higher than those in the control group(P<0.05).No significant differences were observed in cervical disc height and the range of motion of the superior or inferior adjacent vertebrae between the two groups before surgery(P>0.05).The disc height in the observation group was larger than that in the control group after surgery.The range of motion of both the superior and inferior adjacent vertebrae was significantly smaller in the observation group than in the control group(P<0.05).The incidence of complications was only 2.22% in the observation group compared to 15.56% in the control group,and the difference was statistically significant(P<0.05).CONCLUSION Cervical spine function restoration was better with ROI-C with internal fixation in ACDF than with conventional titanium plates in ACDF for CDD disease.