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.

Computer-assisted minimally invasive spine surgery for resection of ossification of the ligamentum flavum in the thoracic spine

Background Ossification of the ligamentum flavum （OLF） has been widely recognized as one of the main causes of thoracic spinal canal stenosis and thoracic myelopathy.Decompression is the only effective strategy for treating thoracic myelopathy caused by OLF.The purpose of this study was to describe the clinical outcomes of computer-assisted minimally invasive spine surgery （CAMISS） for posterior decompression in patients with thoracic myelopathy caused by OLF.Methods In all cases,the surgical procedure was performed with the assistance of an intraoperative three-dimensional navigation system.Decompression of the spinal cord was performed with a high-speed drill; the supraspinal ligaments and spinous process were partially preserved.The outcomes were evaluated by a modified Japanese Orthopedic Association （JOA） scoring system and recovery rates.Results The mean duration of follow-up for the 14 cases was 3.9 years.All patients experienced neurological recovery,the mean JOA score improving from 6.1 points preoperatively to 8.6 points at final follow-up and the mean rate of recovery being 52.7% （excellent in two cases,good in eight,fair in three,and unchanged in one）.Conclusion CAMISS is a safe and effective procedure for resection of the OLF in the thoracic spine.

Minimally invasive lumbar interbody fusion via MAST Quadrant retractor versus open surgery： a prospective randomized clinical trial

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.

Mast Quadrant-assisted Minimally Invasive Modified Transforaminal Lumbar Interbody Fusion： Single Incision Versus Double Incision

Background： The concept of minimally invasive techniques is to make every effort to reduce tissue damage. Certainly, reducing skin incision is an important part of these techniques. This study aimed to investigate the clinical feasibility of Mast Quadrant-assisted modified transforaminal lumbar interbody fusion （TLIF） with a small single posterior median incision. Methods： During the period of March 2011 to March 2012, 34 patients with single-segment degenerative lumbar disease underwent the minimally invasive modified TLIF assisted by Mast Quadrant with a small single posterior median incision （single incision group）. The cases in this group were compared to 37 patients with single-segment degenerative lumbar disease in the double incision group. The perioperative conditions of patients in these two groups were statistically analyzed and compared. The Oswestry Disability Index （ODI） scores, Visual Analog Scale （VAS） scores, and sacrospinalis muscle damage evaluation indicators before operation and 3, 12 months postoperation were compared. Results： A total of 31 and 35 cases in the single incision and double incision groups, respectively, completed at least 12 months of systemic follow-up. The differences in perioperative conditions between the two groups were not statistically significant. The incision length of the single incision group was significantly shorter than that of the double incision group （P 〈 0.01）. The ODI and VAS scores of patients in both groups improved significantly at 3 and 12 months postoperation. However, these two indicators at 3 and 12 months postoperation and the sacrospinalis muscle damage evaluation indicators at 3 months postoperation did not differ significantly between the two groups （P _〉 0.05）. Conclusions： Mast Quadrant-assisted modified TLIF with a small single posterior median incision has excellent clinical feasibility compared to minimally invasive TLIF with a double paramedian incision.

Minimally invasive transforaminal lumbar interbody fusion aided with computer-assisted spinal navigation system combined with electromyography monitoring

Background Minimally invasive techniques are gaining wide-spread application in lumbar fusion surgery, because they may have advantage over conventional open surgery in approach-related morbidity. This research was aimed to evaluate the safety and accuracy of the techniques of minimally invasive transforaminal lumbar interbody fusion by using a computer-assisted spinal navigation system combined with electromyography monitoring. Methods Sixteen patients underwent minimally invasive transforaminal lumbar interbody fusion. A computer-assisted spinal navigation system and electromyography were used for guiding pedicle screw placement. The operative duration, blood loss, complications, and fluoroscopic time were recorded. Clinical outcome was assessed by Visual Analog Scale and Oswestry Disability Index. Radiographic images were obtained to evaluate the accuracy of pedicle screw placement and fusion rates. Results The Visual Analog Scale and Oswestry Disability Index scores were vastly improved postoperatively. A total of 64 pedicle screws were implanted and three were regarded as misplacement by post-operative CT scan. Three screw trajectories were adjusted according to intra-operative stimulus-evoked electromyography monitoring. The average fluoroscopy time in each patient was 31.8 seconds, which equals to 7.9 seconds per pedicle screw. No patients had instrument related neurological complications, infection, implant failure or revision. Successful fusion was found in all patients. Conclusions The combination of navigation system and real-time electromyography monitoring can make the minimally invasive operation more safe and accurate while decreasing radiation exposure time of the medical staff and patient and minimizing the chance and the degree of the pedicle screw misplacement.

Lumbar Facet Cyst Causing S1 Radiculopathy with Concomittent Acute on Chronic Cervical Prolapse Intervertebral Disc, a Rare Case Report

Tandem spinal stenosis is described as concurrent symptomatic cervical and lumbar spinal stenosis. The clinical presentation includes neurogenic claudication, gait disturbance, myelopathy and polyradicuopathy in both upper and lower limbs. A 43-year-old female presented with predominant low back pain with right S1 radiculopathy leading to diagnosis of synovial facet cyst of lumbar spine. She was managed surgically after medical treatment failed. After 1 week post operatively, she presented with severe neck pain with left radiculopathy. MRI revealed acute on chronic cervical prolapsed intervertebral disc, cervical decompression surgery proceeded. Post operative improvement was noted on follow up. We report a case of tandem spinal stenosis, which both of the pathologies were managed with endoscopic approach.