Combining Posterolateral Lumbar Fusion and Posterior Lumber Interbody Fusion Surgery for Treating Three-Level Lumber Spondylolysis and Single-Level Spondylolisthesis: Case Report

Lumbar spondylolysis is a relatively common condition that can cause a variety of clinical manifestations related to the lumbar spine. However, multi-level lumbar spondylolysis is rare and accounts for less than 6% of lumbar spondylolysis. We report a case of three-level lumbar spondylolysis with single-level spondylolisthesis. A 47-year-old woman presented to us with low back pain for 9 years that progressively worsened and the pain was exacerbated with standing and walking. She was diagnosed with three-level lumbar spondylolysis at L3-5 and spondylolisthesis at L4. We performed posterolateral lumber fusion (PLF) and posterior lumbar interbody fusion (PLIF) surgery for her. During the same period, pain recovery and fusion rate of the patient were evaluated after surgery. The results were favorable and proved the efficacy of combining PLF and PLIF technique for treatment for three-level lumbar spondylolysis and single-level spondylolisthesis.

OUTCOME OF POSTEROLATERAL FUSION VERSUS CIRCUMFERENTIAL FUSION WITH CAGE FOR LUMBAR STENOSIS AND LOW DEGREE LUMBAR SPONDYLOLISTHESIS

Objective To evaluate the outcome of two methods for stabilization and fusion: posterolateral fusion and circumferential fusion involving posterior lumbar interbody fusion for lumbar stenosis with Grades 1 and 2 lumbar spondylolisthesis.Methods From April 1998 to April 2003, 45 patients suffering from lumbar stenosis with low degree lumbar spondylolisthesis treated in our hospital were retrospectively reviewed and assigned to two groups.Among them, 24 patients (group A) were treated with instrumented posterolateral fusion and 21 patients (group B) with instrumented circumferential fusion.The two groups were compared for clinical and radiological outcomes.Results All patients were followed up for 12 to 72 months.In group A, results showed preoperative clinical symptoms disappeared completely in 12 of 24 patients, and pain relief was seen in 91.7% (22/24).Two cases suffered from residual symptoms.Twenty-two cases obtained complete reduction of olisthy vertebral bodies, and anatomical reduction rate was 91.7%.No infection or neurological complication occurred in this group.In group B, results showed preoperative clinical symptoms disappeared completely in 13 of 21 patients, and pain relief was seen in 90.5% (19/21).One case suffered from residual symptoms.Twenty cases obtained complete reduction of the olisthy vertebral bodies, and anatomical reduction rate was 95.2%.Four cases of infection or neurological complication occurred in this group.Both groups indicated no significant difference in clinical outcomes and anatomical reduction rate during follow-up.But group A had better intraoperative circumstances and postoperative outcome than group B, while group B had better postoperative parameters in X-ray of Angle of Slipping and Disc Index than group A.Conclusions The first choice of surgical method for lumbar stenosis with low degree lumbar spondylolisthesis is instrumented posterolateral fusion.Only when patients suffer from severe preoperative disc degeneration and low back pain or intervertebral instability should we consider indications for additional use of CAGE.

Meta-Analysis of Clinical Outcomes of Lumbar Fusion Surgical Interventions for Degenerative Spondylolisthesis

Introduction: Surgical interventions for degenerative spondylolisthesis are varied with comparable claims of success. Fusion based technique is one of the most commonly used surgical interventions in treating this condition. The aim of this meta-analysis is to compare the effectiveness of the Lumbar Interbody Fusion techniques (specifically Posterolateral Interbody approach—PLIF) versus Posterolateral Instrumented Fusion (PLF). The clinical outcomes investigated were: back pain, leg pain, function, Oswestery Disability Index (ODI), Disability Rating Index (DRI), fusion and revision rates if reported. Methods: Combinations of keywords and MeSH terms, where appropriate, were used to search for studies in Medline via Ovid, Embase, Cochrane Library, and Google scholar. The initial search was conducted on 10 August 2016 and updated on 13 June 2017. Eligibility criteria for the studies to be selected for this meta-analysis were: Randomised Controlled Trials (RCTs), cohort and consecutive cases studies that compared at PLIF versus PLF surgical interventions at the lumbar region. Heterogeneity indicators and Forest plot were computed using RevMan 5. Results: Out of the initial hits of 3021, 5 articles were selected as relevant and assessed for risk of bias and then data was extracted and tabulated. These 5 studies reported data from (900 patients’ records, follow up ranges from 6 months to 5 years) undergone one of 2 interventions (PLIF or PLF). The overall effect for ODI and leg pain showed no advantage of any intervention over the other while there was a greater odd ratio of fusion if the operation applied PLIF techniques (Overall Z = 2.86, p = 0.004). Conclusions: There is a need for more high quality clinical trials to compare these two interventions. However, available data indicate that there are comparable results in the main clinical outcomes between PLIF and PLF. PLIF has superior fusion rate which does not seem to affect post-operative pain ratings.

Clinical Study of Applying Enhanced Recovery after Surgery Concept in Single-Segment Lumbar Spinal Stenosis Surgery

Objective: With the aging population and changes in lifestyle, lumbar spinal stenosis has become a common spinal disorder. Treatment modalities have been advancing, and the application of Enhanced Recovery After Surgery (ERAS) principles provides a new approach to postoperative recovery in patients. This study aims to investigate the clinical application effects of ERAS principles in single-level lumbar spinal stenosis surgery. Methods: This study included 64 patients who underwent lumbar fusion surgery in the Spinal Surgery Department of Baise People’s Hospital from July 2022 to July 2024. These patients were divided into an experimental group (ERAS group, 33 cases) and a control group (conventional group, 31 cases) based on perioperative care, receiving ERAS principles and traditional treatment, respectively. A comparison was made between the two groups in terms of gender, age, BMI, intraoperative blood loss, postoperative length of hospital stay, postoperative complications, hospital costs, VAS scores (preoperative/postoperative day 3), and ODI scores (preoperative/postoperative day 3). Results: There were no significant differences in gender, age, and BMI between the ERAS group and the conventional group (gender: χ2 = 0.5008, P = 0.4792;age: 54.55 ± 8.51 years vs. 57.39 ± 8.16 years, P = 0.0892;BMI: 25.11 ± 2.70 vs. 24.77 ± 2.75, P = 0.3098). However, during surgery, patients in the ERAS group had significantly less blood loss than those in the conventional group (197.58 ± 195.51ml vs. 438.71 ± 349.22 ml, P = 0.0006), and the postoperative length of hospital stay was significantly shorter (7.00 ± 2.24 days vs. 11.55 ± 5.23 days, P = 0.0000). On postoperative day 3, VAS scores were significantly better in the ERAS group compared to the conventional group (3.70 ± 0.88 vs. 4.32 ± 0.87, P = 0.0031), and the ODI scores showed significant improvement as well (46.00 ± 3.04 vs. 48.00 ± 3.39, P = 0.0078). Although there were no significant differences in postoperative complications and hospital costs (complications: 3 cases vs. 0 cases, P = 0.2154;hospital costs: 63524.29 ± 17891.80 RMB vs. 58733.84 ± 13280.82 RMB, P = 0.1154), ERAS demonstrated better postoperative recovery outcomes in single-level lumbar spinal stenosis surgery. Conclusion: The study results support the implementation of ERAS principles in single-level lumbar spinal stenosis surgery to promote rapid recovery, reduce healthcare resource consumption, and improve overall patient satisfaction.

Predicting Lumbar Spondylolisthesis: A Hybrid Deep Learning Approach

Spondylolisthesis is a chronic disease,and a timely diagnosis of it may help in avoiding surgery.Disease identification in x-ray radiographs is very challenging.Strengthening the feature extraction tool in VGG16 has improved the classification rate.But the fully connected layers of VGG16 are not efficient at capturing the positional structure of an object in images.Capsule network(CapsNet)works with capsules(neuron clusters)rather than a single neuron to grasp the properties of the provided image to match the pattern.In this study,an integrated model that is a combination of VGG16 and CapsNet(S-VCNet)is proposed.In the model,VGG16 is used as a feature extractor.After feature extraction,the output is fed to CapsNet for disease identification.A private dataset is used that contains 466 X-ray radiographs,including 186 images displaying a spine with spondylolisthesis and 280 images depicting a normal spine.The suggested model is the first step towards developing a web-based radiological diagnosis tool that can be utilized in outpatient clinics where there are not enough qualified medical professionals.Experimental results demonstrate that the developed model outperformed the other models that are used for lumbar spondylolisthesis diagnosis with 98%accuracy.After the performance check,the model has been successfully deployed on the Gradio web app platform to produce the outcome in less than 20 s.

Acute deep venous thrombosis induced by May-Thurner syndrome after spondylolisthesis surgery:A case report and review of literature

BACKGROUND Deep venous thrombosis(DVT)is a serious complication of lumbar spine surgery.Current guidelines recommend pharmacomechanical prophylaxis for patients at high risk of DVT after spine surgery.May-Thurner syndrome(MTS),a venous anatomical variation that may require invasive intervention,is an often overlooked cause of DVT.To date,no case reports of symptomatic MTS caused by isthmic spondylolisthesis or subsequent acute DVT after posterior lumbar surgery have been published.CASE SUMMARY We here present a case of a patient who developed acute DVT 4 h after spondylolisthesis surgery,and MTS was only considered after surgery,during a review of a gynecological enhanced computed tomography image taken before the procedure.CONCLUSION In conclusion,clinicians should consider MTS in the presence of a dangerous triad:spondylolisthesis,elevated D-dimer levels,and sonographically indicated unilateral deep vein dilation.Consultation with a vascular surgeon is also essential to MTS management.

Manipulation for degenerative lumbar spondylolisthesis:A systematic review of randomized controlled trials

Objective: To assess the effectiveness and safety of manipulation intervention for degenerative lumbar spondylolisthesis(DLS).Methods: This is a systematic review and meta-analysis. A full-scale retrieval method was performed until February 1, 2021, including nine databases. The homogeneity of different studies was summarized using the Review Manager. The quality of studies was determined with the Cochrane risk-of-bias tool.The evidence quality was graded with the Grading of Recommendations, Assessment, Development, and Evaluations approach.Results: A total of 6 studies involving 524 participants were included. The review demonstrated that manipulation has statistically significant improvements for treating DLS according to Japanese Orthopedic Association scores(mean difference, 3.76;95% confidence interval, 2.63 to 4.90;P <.001) and visual analog scale scores(mean difference,-1.50;95% confidence interval,-1.66 to-1.33;P <.001)compared to the control group. One study reported that the difference in the Oswestry Disability Index between the traction group and the combination of manipulation and traction group was statistically significant(P <.05), while another reported that manipulation treatment can significantly improve the lumbar spine rotation angle on X-ray images compared with the baseline data(P <.05). Moreover, the manipulation group(experimental group) had fewer adverse events than the lumbar traction group(control group).Conclusion: Manipulation intervention is more effective and safer for DLS. Nevertheless, large-scale randomized controlled trials are required to confirm the current conclusions.

Surgical Results of Posterior Lumbar Interbody Fusion with Transpedicular Fixation in Management of Spondylolisthesis

Objective: To evaluate the surgical results of posterior lumber interbody fusion with transpedicular fixation with rod screw system in management of spondylolisthesis. Study Design: Retrospective study reviewed all patient treated by lumber interbody fusion with transpedicular fixation with rod screw system. Patients and Methods: They were 40 patients operated for lumber and lumbosacral spondylolisthesis from Feb 2014 to April 2017 in Al-Azhar university hospital. These patients followed postoperatively clinically for improved neural function and for fusion stability and hardware fixation by radiological investigation. Data about pain intensity (by Visual Analogue Scale) was collected pre- and postoperatively;and outcome was assessed by Oswetry disability index (ODI). Outcome was graded as excellent, good, fair, or poor. Pre- and Post-operative data were statistically compared. Results: The mean age was 45 years (range between 30 - 60 years) with female sex predominance (male:female = 1:3). They had lytic (n = 30) or degenerative (n = 10) spondylolisthesis;and all underwent PLIF (posterior lumbar interbody fusion). In lytic group, the level was L4/L5 in 19 patients and L5/S1 in 11 patients, while in degenerative group the level was L4/L5 in 4 patients, L5/S1 in 3 patients, L2/L3 in 2 and L3/L4 in one patient. The spondylolisthesis grade was grade I among 25 subjects, grade two among 11 subjects and retrolisthesis among 4 subjects. Sensory deficits reported in 22 subjects (19 had lytic and 3 had degenerative spondylolisthesis);while motor deficits reported among 10 subjects and reduced reflexes among 8 subjects. The outcome was excellent, good, and fair among 30, 7, and 3 subjects respectively. The return to previous levels of activity was reported among 32 patients. VAS was 3.5 ± 2.94 at the end of follow up, while ODI was 28% and 36.0% and 3 and 6 months respectively. Conclusion: PLIF associated with transpedicular rod screw fixation system for management of spondylolisthesis is considered a safe and effective surgical intervention in both lytic and degenerative types.

Treatment of Single Level Lumbar Spondylolisthesis with Lumbar Interbody Fusion via Oblique Lateral Approach (OLIF)

Objectives: To investigate the effect of lumbar interbody fusion via the oblique lateral approach (OLIF) in the treatment of single level lumbar spondylolisthesis. Methods: Retrospective analysis was made on 32 cases of single level lumbar spondylolisthesis treated by lumbar interbody fusion via the oblique lateral approach from July 2020 to July 2021. 14 males and 18 females;the age was (66.5 ± 11.5) years (55 - 82 years). 1) The operation time, intraoperative blood loss and complications were recorded;2) the scores of visual analog scale. VAS and Oswestry disability index (ODI) of low back pain and lower limb pain were collected before operation and at the last follow-up;by observing the imaging data, the height of the intervertebral space, the anterior convex angle of the intervertebral space, the anterior convex angle of the lumbar spine, the sagittal diameter of the dural sac and the spondylolisthesis were measured. Results: All patients successfully completed the operation, the average operation time was (103.9 ± 21.1) min, the average intraoperative bleeding volume was (72.3 ± 16.4) ml. There was no vascular injury during the operation, no infection occurred in all surgical incisions, and Class I/A healing was achieved. The VAS scores of low back pain and leg pain before operation and at the last follow-up were lower than those before operation, and the difference was statistically significant (P < 0.05);the ODI at the last follow-up was lower than that before operation, and the difference was statistically significant (P < 0.05). At the last follow-up, the height of intervertebral space, the height of intervertebral foramen and the sagittal diameter of dural sac were greater than those before operation, with statistically significant differences (P < 0.05);the spondylolisthesis rate at the last follow-up was lower than that before operation, with a statistically significant difference (P < 0.05). Left thigh surface numbness occurred in 2 cases (6.3%) and disappeared after 1 week;Hip flexion weakness occurred in 1 case (0.03%), which recovered after 12 days;there were no complications such as retroperitoneal hematoma, ureteral injury, retrograde ejaculation, intestinal and lumbar plexus injury. Conclusion: The early clinical effect of OLIF in the treatment of single level lumbar spondylolisthesis is significant. This surgical method is minimally invasive, safe and effective, which can significantly reduce the amount of intraoperative bleeding and reduce the risk of postoperative complications. Its main working principle is to make the annulus fibrosus, posterior longitudinal ligament and ligamentum flavum shrink and recover the height of the intervertebral space through decompression, loosening and stretching of the intervertebral space, so as to achieve the reduction of the slipped vertebral body, increase the height of the intervertebral foramen Enlarge the spinal canal volume and eliminate dynamic compression to play an indirect decompression role, improve the symptoms of low back and leg pain, and reconstruct the stability of the spine through interbody fusion.

Hot Spots and Frontiers of Research on Degenerative Lumbar Spondylolisthesis in China-Visualization Analysis Based on Citespace

Objective:Through the presentation and visual analysis of the Citespace knowledge map,the future research hotspots and trends of domestic research on degenerative lumbar spondylolisthesis are predicted.Methods:By searching the relevant literature on"degenerative lumbar spondylolisthesis"included in the CNKI database from the establishment of the database to January 1,2021,the annual publication volume,fund projects,research authors,research institutions,and research of the included literature For hotspots and other aspects,visual analysis was carried out with the help of Citespace software.Results:(1)A total of 266 related documents were included,of which 27 were published at the end of 2020;(2)The most funded projects are the National Natural Science Foundation of China(9 projects)and the National Science and Technology Support Program(5 projects);(3)In terms of author analysis,Zhu Liguo(16 articles),Yu Jie(13 articles),and Gao Chunyu(8 articles)rank the top three in terms of author analysis;(4)In terms of research institutions,Wangjing Hospital of China Academy of Chinese Medical Sciences(17 articles),Henan University of Chinese Medicine(4 articles),and Nanjing University of Chinese Medicine(4 articles)were the top 3 research institutions in terms of publication volume;(5)The keyword clustering label was"degenerative lumbar spondylolisthesis","lumbar spine","lumbar spondylolisthesis","degenerative lumbar spondylolisthesis","clinical observation"and"tuina".Conclusion:Research on"degenerative lumbar spondylolisthesis"has gradually received widespread attention,but the amount of publications is still relatively small;relevant domestic researchers and research institutions have formed a certain degree of influence across the country,but large-scale national cooperation research is still scarce,and strengthening academic exchanges and cooperation is still an important direction for researchers and research institutions in this field in the future.The research direction of lumbar spinal stenosis caused by degenerative lumbar spondylolisthesis will be a new direction and entry point for the study of degenerative lumbar spondylolisthesis in recent years.

Surgical strategy for high-grade isthmic spondylolisthesis of 5th lumbar vertebrae

Objective To investigate surgical strategy for high-grade isthmic spondylolisthesis(more thanⅡ degree)of 5th lumbar vertebrae.Methods From August 2003 to October 2008,26 patients with high-grade isthmic spondylolisthesis (L5) were

Clinical observation of bone graft impaction on posterior intervertebral body fusion for lumbar spondylolisthesis

Objective To investigate the clinical effect of bone graft impaction on posterior intervertebral fusion for lumbar spondylolisthesis.Methods From January 2001 to July 2008,36 patients with lumbar spondylolisthesis were treated by

Efficacy and Safety of Low Molecular Weight Heparin Prophylaxis for Venous Thromboembolism Following Lumbar Decompression Surgery

Objective To evaluate the efficacy and safety of low molecular weight heparin (LMWH) prophylaxis for venous thromboembolism (VTE) after lumbar decompression surgery. Methods Patients at high or the highest risk of VTE who underwent lumbar spine surgery in Peking Union Medical College Hospital from January 2004 to April 2011 were included in the present study. All the patients received a half dose of LMWH 6 hours after surgery followed by a full dose LMWH once per day until discharge. We recorded incidences of deep venous thrombosis (DVT), pulmonary embolism (PE), bleeding complications, and medication side effects. Results Seventy-eight consecutive patients were eligible and enrolled in this study. The mean hospital stat was 8.5±4.5 days. No symptomatic DVT, PE, or major bleeding events were observed. One patient developed wound ecchymosis, another developed wound bleeding, four had mild hepatic aminotransferase level elevation, and one developed a suspicious allergic reaction. Conclusion LMWH may be applied as an effective and safe prophylaxis for VTE in high-risk patients undergoing lumbar decompression surgery.

Percutaneous Endoscopic Lumbar Spine Surgery for Lumbar Disc Herniation and Lumbar Spine Stenosis: Emphasizing on Clinical Outcomes of Transforaminal Technique

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.

Clinical Outcome of Percutaneous Endoscopic Lumbar Surgery (PELS) in Treatment of Lumbar Disc Herniation

Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

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.

Erector spinae plane block at lower thoracic level for analgesia in lumbar spine surgery: A randomized controlled trial

BACKGROUND Patients undergoing lumbar spine surgery usually suffer severe pain in the postoperative period.The erector spinae plane block(ESPB),first published in 2016,can anesthetize the ventral and dorsal rami of thoracic nerves and produce an extensive multi-dermatomal sensory block.AIM To assess whether bilateral ultrasound-guided ESPB at a lower thoracic level could improve pain control and quality of recovery in patients undergoing lumbar spine surgery.METHODS A total of 60 patients aged 18-80 years scheduled to undergo lumbar spine surgery with general anesthesia were randomly assigned to two groups:ESPB group(preoperative bilateral ultrasound-guided ESPB at T10 vertebral level)and control group(no preoperative ESPB).Both groups received standard general anesthesia.The main indicator was the duration to the first patient controlled intravenous analgesia(PCIA)bolus.RESULTS In the ESPB group,the duration to the first PCIA bolus was significantly longer than that in the control group(h)[8.0(4.5,17.0)vs 1.0(0.5,6),P<0.01],and resting and coughing numerical rating scale(NRS)scores at 48 h post operation were significantly lower than those in the control group(P<0.05).There was no significant difference between the two groups regarding resting and coughing NRS scores at 24 h post operation.Sufentanil consumption during the operation was significantly lower in the ESPB group than in the control group(P<0.01),while there was no significant difference between the two groups regarding morphine consumption at 24 or 48 h post operation.In the ESPB group,Modified Observer’s Assessment of Alertness/Sedation score within 20 min after extubation was higher and duration in the post-anesthesia care unit was shorter than those in the control group(P<0.01).CONCLUSION In patients undergoing lumbar spine surgery,ultrasound-guided ESPB at a lower thoracic level improves the analgesic effect,reduces opioid consumption,and improves postoperative recovery.

Full-endoscopic spine surgery treatment of lumbar foraminal stenosis after osteoporotic vertebral compression fractures:A case report

BACKGROUND Few reports have described lumbar foraminal stenosis-induced radiculopathy after treatment by full-endoscopic spine surgery(FESS)combined with percutaneous vertebroplasty(PVP)in patients with vertebral compression fractures.We herein report such a case,including the patient’s treatment process and doctor’s surgical experience.CASE SUMMARY A 79-year-old man presented with symptoms of radiculopathy after sustaining L4 vertebral compression fractures.Imaging and physical examination revealed L4 vertebral compression fractures combined with L3/4 Lumbar foraminal stenosis(LFS).The patient’s symptoms were low back pain with pain in the lateral left leg.Although many reports have described radiculopathy induced by osteoporotic vertebral compression fractures,the use of FESS combined with PVP has rarely been reported.This case report indicates that the combination of FESS and PVP is a safe and effective approach for the treatment of LFS-induced radiculopathy after vertebral compression fractures.This minimally invasive technique has great potential to replace traditional lumbar fixation and decompression surgery.Thus,we suggest the continued accumulation of similar cases to discuss the wider application of FESS.CONCLUSION For patients with osteoporotic vertebral compression fracture(OVCF)and LFS,PVP and FESS can be used to restore the vertebral height and reduce the pressure around the intervertebral foramen.Additionally,the combination of FESS and PVP can treat the pain or numbness of the low back and lower limbs and allow for recovery in a short time with excellent postoperative effects.In general,FESS is a good treatment for radiculopathy caused by foraminal stenosis after OVCF.

Transient Symptomatic Bilateral Optic Disc Oedema Following Lumbar Spinal Surgery— An Unusual Presentation

Background: Optic disc oedema has various underlying pathologies, however, unless visually disabling does not usually bring a patient to the physician. The more common symptoms of headache, nausea and vomiting lead to the incidental detection of bilateral disc oedema [1]. Optic disc oedema seen following spinal surgery is usually associated with visual acuity changes and often goes by the acronym POVL (Peri/ postoperative visual loss) wherein, as the name goes, visual acuity changes are profound [2] [3] [4]. Purpose: We would like to highlight a case of transient Bilateral Optic Disc oedema following Lumbar spinal surgery maintaining normal visual acuity and attaining spontaneous resolution. Case Report: A 42-year-old female presented with transient obscuration of vision and flashes of light post an uneventful lumbar spinal surgery. Ophthalmic evaluation revealed normal visual acuity and pupils but marked disc edema right more significant than left. There was no colour vision deficit, neither any field changes. By a process of exclusion, it was likely the patient had developed bilateral disc oedema secondary to the spinal surgery. On follow-up 6 weeks and 3 months later, the oedema had completely settled and visual acuity remained at 6/6. Conclusion: Optic disc oedema can be unilateral or bilateral with some of the uncommon conditions mentioned secondary to spinal surgery, however, in those situations, visual loss has been severe and permanent. Our case is unusual in its combination of disc edema with normal acuity along with its transient nature and resolution and to our knowledge, has not been published before.

Techniques of Surgery for Lumbar Spinal Stenosis: A Comparative Study

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 +/&#8210;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.