AIM:To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS:Fifty-eight patients with large ...AIM:To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS:Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography.Second injections were performed 5 d after the initial injection.All patients were followed up for 6-18 mo.A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy.RESULTS:Successful puncture was obtained in all patients.The overall efficacy was 91.4;the outcome was the excellent in 37 cases(63.8),good in 16 cases(27.6) and fair/poor in 5 cases(8.6) according to the Macnab criteria.No severe complications were found throughout this study.CONCLUSION:Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.展开更多
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 20...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.展开更多
Background Nucleus pulposus of intervertebral discs has proinflammatory characteristics that play a key role in neuropathic pain in lumbar herniated intervertebral disc. One of the most commonly used animal models （t...Background Nucleus pulposus of intervertebral discs has proinflammatory characteristics that play a key role in neuropathic pain in lumbar herniated intervertebral disc. One of the most commonly used animal models （the traditional model） of non-compressive lumbar herniated intervertebral disc is created by L4-L5 hemilaminectomy and the application of autologous nucleus pulposus to cover the left L4 and L5 nerve roots in rats. However, such procedures have the disadvantages of excessive trauma and low success rate. We proposed a modified model of non-compressive lumbar herniated intervertebral disc in which only the left L5 dorsal root ganglion is exposed and transplanted with autologous nucleus pulposus following incision of epineurium. We aimed to compare the modified model with the traditional one with regard to trauma and success rate. Methods Thirty Sprague-Dawley male rats were randomized into three groups： sham operation group （n=6）, traditional group （n=12）, and modified group （n=12）. The amount of blood loss and operative time for each group were analyzed. The paw withdrawal threshold of the left hind limb to mechanical stimuli and paw withdrawal latency to heat stimuli were examined from the day before surgery to day 35 after surgery. Results Compared with the traditional group, the modified group had shorter operative time, smaller amount of blood loss, and higher success rate （91.7% versus 58.3%, P 〈0.05）. There was no decrease in paw withdrawal latency in any group. The sham operation group had no decrease in postoperative paw withdrawal threshold, whereas the modified and traditional groups had significant reduction in paw withdrawal threshold after surgery （mechanical hyperalgesia）. Conclusions Transplantation of nucleus pulposus onto the L5 dorsal root ganglion following incision of epineurium in rats established an improved animal model of non-compressive lumbar herniated intervertebral disc with less trauma and more stable pain ethology.展开更多
Introduction: Low back disc disease (LSD) is a neurosurgical condition with significant socioeconomic repercussions. The objective of this study was to determine the frequency and report the modalities of management. ...Introduction: Low back disc disease (LSD) is a neurosurgical condition with significant socioeconomic repercussions. The objective of this study was to determine the frequency and report the modalities of management. Methodology: This study on lumbosciatic disc disease was carried out in the neurosurgery department of the University Hospital Center (CHU), la Renaissance in N’Djamena. It covered a period of 12 months (from September 2019 to August 2020). A descriptive and an analytical approach were used. The variables studied were epidemiology, clinic, radiology and therapy. Results: the results showed that LSD represented 14.7% of the reasons for consultation in neurosurgery. The average age was 45.8, and to some extent, it ranges between 18 and 76. Lifting was the main reason behind lumbosciatic disc disease with 35.9% of cases, followed by a sedentary life style which represents 30.8%. Lumbosciatica L5 was noted in 49.4%. Obesity and overweight were significant risk factors (P = 0.02) reported in 59% of cases. Motor and sensory deficits were observed in 14.8% and 17.3% of cases, respectively. CT of the lumbar spine was performed in 91% and MRI in 28.9%. The L4-L5 disc herniation represented 74.3% of cases, with a lateral location in 44.2% and L5 radicular impingement in 30.8%. Conservative treatment was instituted in 87.2% and surgical treatment in 12.8% of cases. Conclusion: LSD is caused by a sedentary lifestyle, physical work and overweight. Surgery deals with complicated cases and cases not responding to conservative treatment.展开更多
BACKGROUND The coaxial radiography-guided puncture technique(CR-PT)is a novel technique for endoscopic lumbar discectomy.As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction,t...BACKGROUND The coaxial radiography-guided puncture technique(CR-PT)is a novel technique for endoscopic lumbar discectomy.As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction,the X-ray beam can be used to guide the trajectory angle,facilitating the choice of the puncture site and providing real-time guidance.This puncture technique offers numerous advantages over the conventional anterior-posterior and lateral radiography-guided puncture technique(AP-PT),especially in cases of herniated lumbar discs with a hypertrophied transverse process or articular process,high iliac crest,and narrowed intervertebral foramen.AIM To confirm whether CR-PT is a superior approach to percutaneous transforaminal endoscopic lumbar discectomy compared to AP-PT.METHODS In this parallel,controlled,randomized clinical trial,herniated lumbar disc patients appointed to receive percutaneous endoscopic lumbar discectomy treatment were recruited from the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University and Nantong Hospital of Traditional Chinese Medicine.Sixty-five participants were enrolled and divided into either a CR-PT group or an AP-PT group.The CR-PT group underwent CR-PT,and the AP-PT group underwent AP-PT.The number of fluoroscopies during puncturing,puncture duration(min),surgery duration(min),VAS score during puncturing,and puncture success rate were recorded.RESULTS Sixty-five participants were included,with 31 participants in the CR-PT group and 34 in the AP-PT group.One participant in the AP-PT group dropped out due to unsuccessful puncturing.The number of fluoroscopies[median(P25,P75)]was 12(11,14)in the CR-PT group vs 16(12,23)in the AP-PT group,while the puncture duration(mean±SD)was 20.42±5.78 vs 25.06±5.46,respectively.The VAS score was 3(2,4)in the CR-PT group vs 3(3,4)in the AP-PT group.Further subgroup analysis was performed,considering only the participants with L5/S1 segment herniation:9 patients underwent CR-PT,and 9 underwent AP-PT.The numbe展开更多
Objective： To compare the outcomes of percutaneous laser disc decompression （PLDD） and PLDD with synchronous suction through syringe in the patients with herniated lumbar disc（HLD）. Methods： Forty-two patients w...Objective： To compare the outcomes of percutaneous laser disc decompression （PLDD） and PLDD with synchronous suction through syringe in the patients with herniated lumbar disc（HLD）. Methods： Forty-two patients with HLD on MRI and those who did not respond to conservative treatment for 6 weeks were randomly divided into group A and group B. In group A, the patients were treated with PLDD and those in group B with PLDD and synchronous suction through syringe. GaAIAS diode laser at 810 nm was used for the ablation in both groups. The treatment effect was evaluated by modified MacNab＇s criteria on the 7^th, 30^th and 90^th day. Results： Evaluated by modified MacNab＇s criteria, the percentages of the excellent and good cases in total patients treated for group B and A were 80.95% and 57.14% on the 7^th follow-up day, 85.71% and 66.67% on the 30^th follow-up day, and 95.24% and 71.43% on the 90^th follow-up day, respectively. Conclusion： Synchronous suction technique through syringe during PLDD improves the overall outcome in the treatment of herniated lumbar disc.展开更多
BACKGROUND A high degree of vigilance is warranted for a spinal infection,particularly in a patient who has undergone an invasive procedure such as a spinal injection.The average delay in diagnosing a spinal infection...BACKGROUND A high degree of vigilance is warranted for a spinal infection,particularly in a patient who has undergone an invasive procedure such as a spinal injection.The average delay in diagnosing a spinal infection is 2-4 mo.In our patient,the diagnosis of a spinal infection was delayed by 1.5 mo.CASE SUMMARY A 60-year-old male patient with a 1-year history of right-sided lumbar radicular pain failed conservative treatment.Six weeks to prior to surgery he received a spinal injection,which was followed by increasing lumbar radicular pain,weight loss and chills.This went unnoticed and surgery took place with right-sided L4-L5 combined microdiscectomy and foraminotomy via a posterior approach.The day after surgery,the patient developed left-sided lumbar radicular pain.Blood cultures grew Staphylococcus aureus(S.aureus).Magnetic resonance imaging showed inflammatory aberrations,revealing septic arthritis of the left-sided L4/L5 facet joint as the probable cause.Revision surgery took place and S.aureus was isolated from bacteriological samples.The patient received postoperative antibiotic treatment,which completely eradicated the infection.CONCLUSION The development of postoperative lower back pain and/or lumbar radicular pain can be a sign of a spinal infection.A thorough clinical and laboratory work-up is essential in the preoperative evaluation of patients with spinal pain.展开更多
基金Supported by The National Natural Science Foundation of China,No. 30670612
文摘AIM:To evaluate the effects of percutaneous ozone injection via the posterior-lateral route and inner margin of the facet joint in the treatment of large lumbar disc herniation.METHODS:Fifty-eight patients with large lumbar disc herniation were treated with percutaneous injection of ozone via the posterior-lateral route and inner margin of the facet joint under digital subtraction angiography.Second injections were performed 5 d after the initial injection.All patients were followed up for 6-18 mo.A modified Macnab method was used for assessing clinical outcomes after oxygen-ozone therapy.RESULTS:Successful puncture was obtained in all patients.The overall efficacy was 91.4;the outcome was the excellent in 37 cases(63.8),good in 16 cases(27.6) and fair/poor in 5 cases(8.6) according to the Macnab criteria.No severe complications were found throughout this study.CONCLUSION:Percutaneous intradiscal ozone injection via the posterior-lateral route and inner margin of the facet joint is effective and safe for treatment of large lumbar disc herniation.
文摘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.
基金The study was supported by a grant from the National Natural Science Foundation of China-Guangdong Joint Funding （No. u0732001）.
文摘Background Nucleus pulposus of intervertebral discs has proinflammatory characteristics that play a key role in neuropathic pain in lumbar herniated intervertebral disc. One of the most commonly used animal models （the traditional model） of non-compressive lumbar herniated intervertebral disc is created by L4-L5 hemilaminectomy and the application of autologous nucleus pulposus to cover the left L4 and L5 nerve roots in rats. However, such procedures have the disadvantages of excessive trauma and low success rate. We proposed a modified model of non-compressive lumbar herniated intervertebral disc in which only the left L5 dorsal root ganglion is exposed and transplanted with autologous nucleus pulposus following incision of epineurium. We aimed to compare the modified model with the traditional one with regard to trauma and success rate. Methods Thirty Sprague-Dawley male rats were randomized into three groups： sham operation group （n=6）, traditional group （n=12）, and modified group （n=12）. The amount of blood loss and operative time for each group were analyzed. The paw withdrawal threshold of the left hind limb to mechanical stimuli and paw withdrawal latency to heat stimuli were examined from the day before surgery to day 35 after surgery. Results Compared with the traditional group, the modified group had shorter operative time, smaller amount of blood loss, and higher success rate （91.7% versus 58.3%, P 〈0.05）. There was no decrease in paw withdrawal latency in any group. The sham operation group had no decrease in postoperative paw withdrawal threshold, whereas the modified and traditional groups had significant reduction in paw withdrawal threshold after surgery （mechanical hyperalgesia）. Conclusions Transplantation of nucleus pulposus onto the L5 dorsal root ganglion following incision of epineurium in rats established an improved animal model of non-compressive lumbar herniated intervertebral disc with less trauma and more stable pain ethology.
文摘Introduction: Low back disc disease (LSD) is a neurosurgical condition with significant socioeconomic repercussions. The objective of this study was to determine the frequency and report the modalities of management. Methodology: This study on lumbosciatic disc disease was carried out in the neurosurgery department of the University Hospital Center (CHU), la Renaissance in N’Djamena. It covered a period of 12 months (from September 2019 to August 2020). A descriptive and an analytical approach were used. The variables studied were epidemiology, clinic, radiology and therapy. Results: the results showed that LSD represented 14.7% of the reasons for consultation in neurosurgery. The average age was 45.8, and to some extent, it ranges between 18 and 76. Lifting was the main reason behind lumbosciatic disc disease with 35.9% of cases, followed by a sedentary life style which represents 30.8%. Lumbosciatica L5 was noted in 49.4%. Obesity and overweight were significant risk factors (P = 0.02) reported in 59% of cases. Motor and sensory deficits were observed in 14.8% and 17.3% of cases, respectively. CT of the lumbar spine was performed in 91% and MRI in 28.9%. The L4-L5 disc herniation represented 74.3% of cases, with a lateral location in 44.2% and L5 radicular impingement in 30.8%. Conservative treatment was instituted in 87.2% and surgical treatment in 12.8% of cases. Conclusion: LSD is caused by a sedentary lifestyle, physical work and overweight. Surgery deals with complicated cases and cases not responding to conservative treatment.
文摘BACKGROUND The coaxial radiography-guided puncture technique(CR-PT)is a novel technique for endoscopic lumbar discectomy.As the X-ray beam and the puncturing needle are maintained in a parallel and coaxial direction,the X-ray beam can be used to guide the trajectory angle,facilitating the choice of the puncture site and providing real-time guidance.This puncture technique offers numerous advantages over the conventional anterior-posterior and lateral radiography-guided puncture technique(AP-PT),especially in cases of herniated lumbar discs with a hypertrophied transverse process or articular process,high iliac crest,and narrowed intervertebral foramen.AIM To confirm whether CR-PT is a superior approach to percutaneous transforaminal endoscopic lumbar discectomy compared to AP-PT.METHODS In this parallel,controlled,randomized clinical trial,herniated lumbar disc patients appointed to receive percutaneous endoscopic lumbar discectomy treatment were recruited from the Pain Management Department of the Affiliated Hospital of Xuzhou Medical University and Nantong Hospital of Traditional Chinese Medicine.Sixty-five participants were enrolled and divided into either a CR-PT group or an AP-PT group.The CR-PT group underwent CR-PT,and the AP-PT group underwent AP-PT.The number of fluoroscopies during puncturing,puncture duration(min),surgery duration(min),VAS score during puncturing,and puncture success rate were recorded.RESULTS Sixty-five participants were included,with 31 participants in the CR-PT group and 34 in the AP-PT group.One participant in the AP-PT group dropped out due to unsuccessful puncturing.The number of fluoroscopies[median(P25,P75)]was 12(11,14)in the CR-PT group vs 16(12,23)in the AP-PT group,while the puncture duration(mean±SD)was 20.42±5.78 vs 25.06±5.46,respectively.The VAS score was 3(2,4)in the CR-PT group vs 3(3,4)in the AP-PT group.Further subgroup analysis was performed,considering only the participants with L5/S1 segment herniation:9 patients underwent CR-PT,and 9 underwent AP-PT.The numbe
文摘Objective： To compare the outcomes of percutaneous laser disc decompression （PLDD） and PLDD with synchronous suction through syringe in the patients with herniated lumbar disc（HLD）. Methods： Forty-two patients with HLD on MRI and those who did not respond to conservative treatment for 6 weeks were randomly divided into group A and group B. In group A, the patients were treated with PLDD and those in group B with PLDD and synchronous suction through syringe. GaAIAS diode laser at 810 nm was used for the ablation in both groups. The treatment effect was evaluated by modified MacNab＇s criteria on the 7^th, 30^th and 90^th day. Results： Evaluated by modified MacNab＇s criteria, the percentages of the excellent and good cases in total patients treated for group B and A were 80.95% and 57.14% on the 7^th follow-up day, 85.71% and 66.67% on the 30^th follow-up day, and 95.24% and 71.43% on the 90^th follow-up day, respectively. Conclusion： Synchronous suction technique through syringe during PLDD improves the overall outcome in the treatment of herniated lumbar disc.
文摘BACKGROUND A high degree of vigilance is warranted for a spinal infection,particularly in a patient who has undergone an invasive procedure such as a spinal injection.The average delay in diagnosing a spinal infection is 2-4 mo.In our patient,the diagnosis of a spinal infection was delayed by 1.5 mo.CASE SUMMARY A 60-year-old male patient with a 1-year history of right-sided lumbar radicular pain failed conservative treatment.Six weeks to prior to surgery he received a spinal injection,which was followed by increasing lumbar radicular pain,weight loss and chills.This went unnoticed and surgery took place with right-sided L4-L5 combined microdiscectomy and foraminotomy via a posterior approach.The day after surgery,the patient developed left-sided lumbar radicular pain.Blood cultures grew Staphylococcus aureus(S.aureus).Magnetic resonance imaging showed inflammatory aberrations,revealing septic arthritis of the left-sided L4/L5 facet joint as the probable cause.Revision surgery took place and S.aureus was isolated from bacteriological samples.The patient received postoperative antibiotic treatment,which completely eradicated the infection.CONCLUSION The development of postoperative lower back pain and/or lumbar radicular pain can be a sign of a spinal infection.A thorough clinical and laboratory work-up is essential in the preoperative evaluation of patients with spinal pain.
