AIM: To compare minimally invasive(MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion(TLIF) surgeries with respect to length of surgery, estimated blood loss...AIM: To compare minimally invasive(MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion(TLIF) surgeries with respect to length of surgery, estimated blood loss(EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay(LOS).METHODS: A systematic review of previously published studies accessible through Pub Med was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery(177.5 min vs 129.0 min, P = 0.04), shorter LOS(4.3 d vs 5.3 d, P = 0.01) and less perioperative pain(visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients(postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL(352 mL vs 580 mL, P < 0.0001) and LOS(7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find noninferior perioperative outcomes at this time.展开更多
Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western wor...Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology andsurgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.展开更多
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 pat...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.展开更多
Background: For decades, traditional open surgical techniques were used to treat lumbar disc herniation and lumbar canal stenosis (LCS). However, seeking for better outcomes for patients and avoiding extensive bony lo...Background: For decades, traditional open surgical techniques were used to treat lumbar disc herniation and lumbar canal stenosis (LCS). However, seeking for better outcomes for patients and avoiding extensive bony loss with its sequences had raised minimally invasive technique for treating these disorders as an alternative surgery. Methods: This is a retrospective study in which 54 patients of LCS were operated upon via unilateral minimally invasive technique to decompress the canal in a 360 degrees fashion through laminotomy, deroofing of opposite laminar side, sublaminar ligamintectomy, bilateral foraminotomies and discectomy. We used VAS scores and ODI to assess clinical outcomes with a period of one year follow-up. Results: Our results demonstrated that minimally invasive techniques for treating these disorders are effective procedures. Minimally invasive 360 degrees decompression for treating LCS had better outcomes regarding postoperative back pain, smaller incisions, less bony loss and early ambulation. Conclusion: Minimally invasive techniques for treating lumbar canal stenosis of different causes could be considered a better option instead of traditional full laminectomy with better outcomes as regards respecting the anatomical layers such as posterior spinal integrity and musculature, postoperative pain, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods.展开更多
Aim: To compare between classic open surgeries and minimally invasive surgeries in Lumbar Spinal Stenosis. Methods: A comparative descriptive study, involved 117 patients suffering from lumbar canal stenosis, aged bet...Aim: To compare between classic open surgeries and minimally invasive surgeries in Lumbar Spinal Stenosis. Methods: A comparative descriptive study, involved 117 patients suffering from lumbar canal stenosis, aged between 40 - 70 years;admitted to department of Neurosurgery from March 2011 till august 2016 in King Fahad Hospital in Saudi Arabia. Study groups are consisted of group A as patients managed with classical laminectomy, group B as patients managed with endoscopic spinal procedures and group C as patients managed with microscopic decompression facilitated by the Metrex Tubular System. SPSS was used in data entry and analysis, and ethical considerations taken into consideration and participants filled the required inform consents. Results: Age of particaoncet ranged from 45 - 63 years, Mean +/‒50. The degenerative canal stenosis with acute disc single level (cauda equina syndrome) was the most common type of lumbar canal stenosis encountered in group A;the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group B;while the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group C. Classic laminectomy and disectomy used mostly in group A;endoscopic unilateral decompression lamino-foraminotomy without discectomy used mostly in group B and bilateral microscopic laminectomy without discectomy followed by unilateral microscopic laminoforaminotomy without discectomy used mostly in group C. Mean of operation duration was the highest in both gender of group A, followed by group B, then group C. Unintended durotomy was the most common intra operative complications occurred in the whole study especially in group A. Mean of blood lost was the highest in both gender of group A, followed by group B, then group C. Postop complications in the patients of study groups were the highest in group A (33.3%), followed by group B (8.5%) and then group C (2%). Conclusion: Microscopic decompression facilitated by the Metrex Tubular System is the most effective technique of Surgery for Lumbar Spinal Stenosis and the least intra-operative and post-operative complications.展开更多
In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally i...In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors, postoperative back muscle function, and 24-month postoperative follow-up results. Methods From September 2006 to June 2008, patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study. Patients were randomized to undergo either minimally invasive surgery （MIS, transforaminal lumbar interbody fusion via MAST Quadrant retractor, 41 cases） or open surgery （improved transforaminal lumbar interbody fusion, 38 cases）. Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group, and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group （P 〈0.05 for all）. MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery （P 〈0.01）. Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group （P 〈0.01）. The Oswestry disability index and visual analog scale scores were better at 3, 6, 12 and 24 months postoperatively than preoperatively in both groups. Both groups of patients met the imaging convergence criteria at the last follow-up. Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery, which is conducive to early functional recovery. In the short term, MIS is superior to open surgery, but in the long term there is no significant difference between the two procedures.展开更多
Interspinous posterior device(IPD) is a term used to identify a relatively recent group of implants used to treat lumbar spinal degenerative disease. This kind of device is classified as part of the group of the dynam...Interspinous posterior device(IPD) is a term used to identify a relatively recent group of implants used to treat lumbar spinal degenerative disease. This kind of device is classified as part of the group of the dynamic stabilization systems of the spine. The concept of dynamic stabilization has been replaced by that of dynamic neutralization of hypermobility, with the intention of clarifying that the primary aim of this kind of system is not the preservation of the movement, but the dynamic neutralization of the segmental hypermobility which is at the root of the pathological condition. The indications for the implantation of an IPD are spinal stenosis and neurogenic claudication, assuming that its function is the enlargement of the neural foramen and the decompression of the roots forming the cauda equina in the central part of the vertebral canal. In the last 10 years, use of these implants has been very common but to date, no long-term clinical follow-up regarding clinical and radiological aspects are available. The high rate of reoperation, recurrence of symptoms and progression of degenerative changes is evident in the literature. If these devices are effectively a miracle cure for lumbar spinal stenosis, why do the utilization and implantation of IPD remain extremely controversial and should they be investigated further? Excluding theproblems related to the high cost of the device, the main problem remains the pathological substrate on which the device is explicit in its action: the degenerative pathology of the spine.展开更多
To review the clinical efficacy of minimally invasive pedicle fixation combined with anterior small incision focus debridement for single-segment lumbar spine tuberculosis,a total of 31 patients with single-segment ma...To review the clinical efficacy of minimally invasive pedicle fixation combined with anterior small incision focus debridement for single-segment lumbar spine tuberculosis,a total of 31 patients with single-segment marginal lumbar tuberculosis were enrolled in the study.All the patients received quadruple anti-tuberculosis chemotherapy for 2 weeks before surgery and treatment with minimally invasive posterior internal fixation,anterior small incision focus debridement,and bone graft fusion.Those patients with preoperative kyphosis deformity were initially treated with appropriate posterior distraction correction.Except for 1 patient who healed 2 weeks after medical dressing change,the remaining30 patients healed as expected.All the patients had no screwrelated surgical complications,neurological dysfunction,vascular injury,and other complications.The average visual analog scale scores at 3 months postoperatively were significantly decreased to1.4±1.5(P<0.05).In conclusion,under the premise of treatment using appropriate,effective anti-tuberculosis agents,this surgical procedure for managing patients with lumbar vertebral tuberculosis achieved satisfactory results,effectively reducing the exposure range and fusion segments in simple anterior focus debridement and internal fixation.Using minimally invasive posterior pedicle screw fixation can effectively increase spine stability,reduce fusion segment,and decrease anterior surgical trauma and complications.展开更多
Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether ...Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.展开更多
背景经皮脊柱内镜手术治疗腰椎间盘突出症的日间手术模式逐渐在国内开展,日间手术模式和住院手术模式对于患者心理状态的影响鲜有报道。目的探讨在日间手术与住院手术模式下经皮脊柱内镜手术对于患者心理状态的影响及差异。方法收集2020...背景经皮脊柱内镜手术治疗腰椎间盘突出症的日间手术模式逐渐在国内开展,日间手术模式和住院手术模式对于患者心理状态的影响鲜有报道。目的探讨在日间手术与住院手术模式下经皮脊柱内镜手术对于患者心理状态的影响及差异。方法收集2020年1月—2023年1月在解放军总医院第一医学中心骨科接受经皮脊柱内镜腰椎间盘切除术(percutaneous endoscopic lumbar diskectomy,PELD)患者的临床资料,应用倾向评分匹配(propensity score matching,PSM)法对日间手术组和住院手术组患者按照1∶1进行匹配。比较日间手术组和住院手术组术前术后以及两组之间的Zung焦虑自评量表(self-assessment anxiety scale,SAS)评分、Zung抑郁自评量表(self-assessment depression scale,SDS)评分、下肢疼痛视觉模拟评分(visual analog scale of lower limbs,VAS-L)、背部疼痛视觉模拟评分(visual analog scale of back,VAS-B)、日本骨科医师协会评分(Japanese Orthopaedic Association,JOA)和Oswestry功能障碍指数(Oswestry disability index,ODI)。结果匹配后日间手术组和住院手术组各纳入50例患者。日间手术组中,男性31例,女性19例,平均年龄(43.06±15.22)岁,平均病程(20.39±38.41)个月;住院手术组中,男性29例,女性21例,平均年龄(41.40±14.84)岁,平均病程(22.27±40.38)个月,两组一般资料差异无统计学意义(P>0.05)。术前,日间手术组与住院手术组心理学评分及异常率的差异均无统计学意义(P>0.05)。术后,两组各个时间点的SAS评分、SDS评分和异常率均优于术前(P<0.05)。日间手术组与住院手术组相比,出院时的SAS评分差异有统计学意义(34.52±3.43 vs 36.58±4.52,P<0.05),SAS评分异常率差异有统计学意义(16%vs 34%,P=0.038);术后1周的SAS评分差异有统计学意义(28.77±2.52 vs 31.18±3.17,P<0.01);术后其他时间点的SAS评分、SDS评分和异常率差异均无统计学意义(P>0.05)。此外,两组术后3个月的临床疗效均优于术前(P<0.05);两组间术后3个月临床疗效的差异无统计学意义(P>0.05)。结论住院手术和日间手术模式下,PELD术后患者的焦虑和抑郁状态较术前均有改善。相较于住院手术模式,日间手术模式下,术后短期内处于焦虑状态的患者比例更低。展开更多
文摘AIM: To compare minimally invasive(MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion(TLIF) surgeries with respect to length of surgery, estimated blood loss(EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay(LOS).METHODS: A systematic review of previously published studies accessible through Pub Med was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery(177.5 min vs 129.0 min, P = 0.04), shorter LOS(4.3 d vs 5.3 d, P = 0.01) and less perioperative pain(visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients(postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL(352 mL vs 580 mL, P < 0.0001) and LOS(7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find noninferior perioperative outcomes at this time.
文摘Degenerative disease of the lumbar spine is a common and increasingly prevalent condition that is often implicated as the primary reason for chronic low back pain and the leading cause of disability in the western world. Surgical management of lumbar degenerative disease has historically been approached by way of open surgical procedures aimed at decompressing and/or stabilizing the lumbar spine. Advances in technology andsurgical instrumentation have led to minimally invasive surgical techniques being developed and increasingly used in the treatment of lumbar degenerative disease. Compared to the traditional open spine surgery, minimally invasive techniques require smaller incisions and decrease approach-related morbidity by avoiding muscle crush injury by self-retaining retractors, preventing the disruption of tendon attachment sites of important muscles at the spinous processes, using known anatomic neurovascular and muscle planes, and minimizing collateral soft-tissue injury by limiting the width of the surgical corridor. The theoretical benefits of minimally invasive surgery over traditional open surgery include reduced blood loss, decreased postoperative pain and narcotics use, shorter hospital length of stay, faster recover and quicker return to work and normal activity. This paper describes the different minimally invasive techniques that are currently available for the treatment of degenerative disease of the lumbar spine.
文摘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.
文摘Background: For decades, traditional open surgical techniques were used to treat lumbar disc herniation and lumbar canal stenosis (LCS). However, seeking for better outcomes for patients and avoiding extensive bony loss with its sequences had raised minimally invasive technique for treating these disorders as an alternative surgery. Methods: This is a retrospective study in which 54 patients of LCS were operated upon via unilateral minimally invasive technique to decompress the canal in a 360 degrees fashion through laminotomy, deroofing of opposite laminar side, sublaminar ligamintectomy, bilateral foraminotomies and discectomy. We used VAS scores and ODI to assess clinical outcomes with a period of one year follow-up. Results: Our results demonstrated that minimally invasive techniques for treating these disorders are effective procedures. Minimally invasive 360 degrees decompression for treating LCS had better outcomes regarding postoperative back pain, smaller incisions, less bony loss and early ambulation. Conclusion: Minimally invasive techniques for treating lumbar canal stenosis of different causes could be considered a better option instead of traditional full laminectomy with better outcomes as regards respecting the anatomical layers such as posterior spinal integrity and musculature, postoperative pain, accompanied with less blood loss, shorter hospital stays, and shorter recovery periods.
文摘Aim: To compare between classic open surgeries and minimally invasive surgeries in Lumbar Spinal Stenosis. Methods: A comparative descriptive study, involved 117 patients suffering from lumbar canal stenosis, aged between 40 - 70 years;admitted to department of Neurosurgery from March 2011 till august 2016 in King Fahad Hospital in Saudi Arabia. Study groups are consisted of group A as patients managed with classical laminectomy, group B as patients managed with endoscopic spinal procedures and group C as patients managed with microscopic decompression facilitated by the Metrex Tubular System. SPSS was used in data entry and analysis, and ethical considerations taken into consideration and participants filled the required inform consents. Results: Age of particaoncet ranged from 45 - 63 years, Mean +/‒50. The degenerative canal stenosis with acute disc single level (cauda equina syndrome) was the most common type of lumbar canal stenosis encountered in group A;the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group B;while the unilateral foraminal and lateral recess stenosis without disc prolapse was the most common type of lumbar canal stenosis encountered in group C. Classic laminectomy and disectomy used mostly in group A;endoscopic unilateral decompression lamino-foraminotomy without discectomy used mostly in group B and bilateral microscopic laminectomy without discectomy followed by unilateral microscopic laminoforaminotomy without discectomy used mostly in group C. Mean of operation duration was the highest in both gender of group A, followed by group B, then group C. Unintended durotomy was the most common intra operative complications occurred in the whole study especially in group A. Mean of blood lost was the highest in both gender of group A, followed by group B, then group C. Postop complications in the patients of study groups were the highest in group A (33.3%), followed by group B (8.5%) and then group C (2%). Conclusion: Microscopic decompression facilitated by the Metrex Tubular System is the most effective technique of Surgery for Lumbar Spinal Stenosis and the least intra-operative and post-operative complications.
文摘In recent years, a variety of minimally invasive lumbar surgery techniques have achieved desirable efficacy, but some dispute remains regarding the advantages over open surgery. This study aimed to compare minimally invasive lumbar interbody fusion via MAST Quadrant retractor with open surgery in terms of perioperative factors, postoperative back muscle function, and 24-month postoperative follow-up results. Methods From September 2006 to June 2008, patients with single-level degenerative lumbar spine disease who were not responsive to conservative treatment were enrolled in this study. Patients were randomized to undergo either minimally invasive surgery （MIS, transforaminal lumbar interbody fusion via MAST Quadrant retractor, 41 cases） or open surgery （improved transforaminal lumbar interbody fusion, 38 cases）. Results The MIS group had longer intraoperative fluoroscopy time than the open surgery group, and the open surgery group had significantly increased postoperative drainage volume and significantly prolonged postoperative recovery time compared with the MIS group （P 〈0.05 for all）. MRI scanning showed that the T2 relaxation time in the multifidus muscle was significantly shorter in the MIS group than in the open surgery group at 3 months after surgery （P 〈0.01）. Surface electromyography of the sacrospinalis muscle showed that the average discharge amplitude and frequency were significantly higher in the MIS group than in the open surgery group （P 〈0.01）. The Oswestry disability index and visual analog scale scores were better at 3, 6, 12 and 24 months postoperatively than preoperatively in both groups. Both groups of patients met the imaging convergence criteria at the last follow-up. Conclusions MIS can effectively reduce sacrospinalis muscle injury compared with open surgery, which is conducive to early functional recovery. In the short term, MIS is superior to open surgery, but in the long term there is no significant difference between the two procedures.
文摘Interspinous posterior device(IPD) is a term used to identify a relatively recent group of implants used to treat lumbar spinal degenerative disease. This kind of device is classified as part of the group of the dynamic stabilization systems of the spine. The concept of dynamic stabilization has been replaced by that of dynamic neutralization of hypermobility, with the intention of clarifying that the primary aim of this kind of system is not the preservation of the movement, but the dynamic neutralization of the segmental hypermobility which is at the root of the pathological condition. The indications for the implantation of an IPD are spinal stenosis and neurogenic claudication, assuming that its function is the enlargement of the neural foramen and the decompression of the roots forming the cauda equina in the central part of the vertebral canal. In the last 10 years, use of these implants has been very common but to date, no long-term clinical follow-up regarding clinical and radiological aspects are available. The high rate of reoperation, recurrence of symptoms and progression of degenerative changes is evident in the literature. If these devices are effectively a miracle cure for lumbar spinal stenosis, why do the utilization and implantation of IPD remain extremely controversial and should they be investigated further? Excluding theproblems related to the high cost of the device, the main problem remains the pathological substrate on which the device is explicit in its action: the degenerative pathology of the spine.
基金supported by the National Natural Science Foundation of China(No.81272024).
文摘To review the clinical efficacy of minimally invasive pedicle fixation combined with anterior small incision focus debridement for single-segment lumbar spine tuberculosis,a total of 31 patients with single-segment marginal lumbar tuberculosis were enrolled in the study.All the patients received quadruple anti-tuberculosis chemotherapy for 2 weeks before surgery and treatment with minimally invasive posterior internal fixation,anterior small incision focus debridement,and bone graft fusion.Those patients with preoperative kyphosis deformity were initially treated with appropriate posterior distraction correction.Except for 1 patient who healed 2 weeks after medical dressing change,the remaining30 patients healed as expected.All the patients had no screwrelated surgical complications,neurological dysfunction,vascular injury,and other complications.The average visual analog scale scores at 3 months postoperatively were significantly decreased to1.4±1.5(P<0.05).In conclusion,under the premise of treatment using appropriate,effective anti-tuberculosis agents,this surgical procedure for managing patients with lumbar vertebral tuberculosis achieved satisfactory results,effectively reducing the exposure range and fusion segments in simple anterior focus debridement and internal fixation.Using minimally invasive posterior pedicle screw fixation can effectively increase spine stability,reduce fusion segment,and decrease anterior surgical trauma and complications.
文摘Study Design: Original article. Objective: Guidelines for deciding whether to perform open or percutaneous surgery in burst fractures. Summary of Background Data: The authors propose an algorithm for deciding whether to perform open surgery or percutaneous surgery with short fixation in patients with fractures of the thoracolumbar junction and lumbar spine. Methods: Between July 2005 and July 2009, 72 patients underwent surgical stabilization by posterior route for fractures of the thoracolumbar junction and lumbar spine. In 44 the lesion involved the thoracolumbar junction, in 28 the lumbar spine (L2 in6 cases, L3 in15 cases, L5 in7 cases). The fractures were assessed morphologically according to Magerl’s classification (52 type A, 12 type B, 8 type C). All patients were analyzed according to the algorithm proposed, according to which patients must fulfil certain criteria: the fracture must be Magerl type A.3, it must involve one level, McCormack score must be 6 or less, invasion of the spinal canal must be 25% or less according to Hashimoto’s formula, Magnetic Resonance Imating (MRI) must confirm discoligamentous integrity. Neurologically, the patient must be ASIA E. 25 patients (17 thoracolumbar junction, 8 lumbar spine) fulfilled these criteria and were treated by percutaneous short fixation. Results: The average length of the surgical procedure was 80 minutes and the loss of blood 10 cc. All patients were dismissed without brace and were submitted to follow-upComputed Tomography CTscan 3 and 6 months after surgery. Follow-up ranged from 6 months to 4 years. In all cases CT scan confirmed fusion and there were no cases of rupture of the device. None of the patients presented neurological deficits. Conclusion: The algorithm described permits a proper selection of patients with thoracolumbar fractures who can be treated by percutaneous short fixation, thus avoiding the risks connected with failure of the stabilization system.
文摘背景经皮脊柱内镜手术治疗腰椎间盘突出症的日间手术模式逐渐在国内开展,日间手术模式和住院手术模式对于患者心理状态的影响鲜有报道。目的探讨在日间手术与住院手术模式下经皮脊柱内镜手术对于患者心理状态的影响及差异。方法收集2020年1月—2023年1月在解放军总医院第一医学中心骨科接受经皮脊柱内镜腰椎间盘切除术(percutaneous endoscopic lumbar diskectomy,PELD)患者的临床资料,应用倾向评分匹配(propensity score matching,PSM)法对日间手术组和住院手术组患者按照1∶1进行匹配。比较日间手术组和住院手术组术前术后以及两组之间的Zung焦虑自评量表(self-assessment anxiety scale,SAS)评分、Zung抑郁自评量表(self-assessment depression scale,SDS)评分、下肢疼痛视觉模拟评分(visual analog scale of lower limbs,VAS-L)、背部疼痛视觉模拟评分(visual analog scale of back,VAS-B)、日本骨科医师协会评分(Japanese Orthopaedic Association,JOA)和Oswestry功能障碍指数(Oswestry disability index,ODI)。结果匹配后日间手术组和住院手术组各纳入50例患者。日间手术组中,男性31例,女性19例,平均年龄(43.06±15.22)岁,平均病程(20.39±38.41)个月;住院手术组中,男性29例,女性21例,平均年龄(41.40±14.84)岁,平均病程(22.27±40.38)个月,两组一般资料差异无统计学意义(P>0.05)。术前,日间手术组与住院手术组心理学评分及异常率的差异均无统计学意义(P>0.05)。术后,两组各个时间点的SAS评分、SDS评分和异常率均优于术前(P<0.05)。日间手术组与住院手术组相比,出院时的SAS评分差异有统计学意义(34.52±3.43 vs 36.58±4.52,P<0.05),SAS评分异常率差异有统计学意义(16%vs 34%,P=0.038);术后1周的SAS评分差异有统计学意义(28.77±2.52 vs 31.18±3.17,P<0.01);术后其他时间点的SAS评分、SDS评分和异常率差异均无统计学意义(P>0.05)。此外,两组术后3个月的临床疗效均优于术前(P<0.05);两组间术后3个月临床疗效的差异无统计学意义(P>0.05)。结论住院手术和日间手术模式下,PELD术后患者的焦虑和抑郁状态较术前均有改善。相较于住院手术模式,日间手术模式下,术后短期内处于焦虑状态的患者比例更低。
