Among the 413 patients of the lumbar herniated nucleus pulposus(HNP) who were admitted and treated at Dong-A University Hospital from March 1990 to May 1994, we analyzed 387 patients who checked magnetic resonance imaging(MRI). MRI study followed by open disectomy was carried out on 127 patients of the lumbar HNP, and we analyzed the clinical and operative findings of the lumbar HNP and compared these with MRI findings. The following results were obtained. 1. MRI findings of 387 patients consisted of bulging discs in 107 cases(27.6%), protruded discs in 165 cases(42.6%), extruded subligamentous discs in 73 cases(18.9%), extruded transligamentous discs in 34 cases(8.8%) and sequestered discs in 8 cases(2.1%). 2. MRI findings of 127 patients who had been treated with open discectomy consisted of protruded discs in 53 cases(41.7%), extruded subligamentous discs in 47 cases(37.0%), extruded transligamentous discs in 19 cases(15.0%) and sequestered discs in 8 cases(6.3%). 3. Operative findings revealed the protruded discs: 49 cases(38.6%), extruded subligamentous discs: 52 cases(40.9%), extruded transligamentous discs: 18 cases(14.2%) and sequestered discs: 8 cases(6.3%). 4. In sequestered disc, we could get the highest sensitivity, specificity and accuracy with MRI in distinguishing from another type of lumbar HNP. MRI can be available for accurate assessment of type and location of the lumbar HNP and it can show the high specificity, sensitivity and accuracy in preoperative diagnostic method.
Diskectomy ; Humans ; Magnetic Resonance Imaging ; Methods ; Sensitivity and Specificity

OBJECTIVE: To compare the clinical efficacy between visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy (VPTED) and traditional percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation. METHODS: The clinical data of 60 patients with lumbar disc herniation admitted from June 2019 to December, 2020 was retrospectively analyzed. There were 38 males and 22 females, aged from 26 to 58 years old with an average of (43.63±8.48) years, 47 cases were on L_4,5 segment and 13 cases were on L₅S₁ segment. Among them, 32 were treated with VPTED (group A) and 28 were treated with traditional PTED (group B). The general conditions of all the patients were recorded, including intraoperative fluoroscopy times, operation time, hospital stay and surgical complications during follow-up. The arthroplasty area ratio was observed by sagittal CT at the middle level of the intervertebral foramen. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score of low back pain, Oswestry disability index (ODI) were used to evaluate the clinical efficacy between two groups. RESULTS: All patients were followed up from 9 to 15 months with an average of (12.10±1.16) months. There was no statistical difference of preoperative general data between two groups. The operation time, fluoroscopy times and hospital stay were (70.47±5.87) min, (13.66±1.34) times and (6.31±0.69) d in group A, and (90.71±7.66) min, (22.82±2.48) times and (6.54±0.92) d in group B. The operation time and intraoperative fluoroscopy times in group A were lower than those in group B(P<0.05). There was no significant difference in hospital stay between two groups (P>0.05). No obvious surgical complications were found during the follow-up in both groups. The arthroplasty area ratio in group A was (29.72±2.84)% and (29.57±2.20)% in group B, respectively, with no significant difference (P>0.05). There was no significant difference in VAS, ODI and JOA score between two groups before operation and at the final follow-up(P>0.05), but the final follow-up was significantly improved(P<0.05). CONCLUSION The two surgical methods have definite clinical efficacy in the treatment of lumbar disc herniation. Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy has the advantages of high efficiency and rapidity when establishing the channel, and can significantly reduce the operation time and intraoperative fluoroscopy times.
Male ; Female ; Humans ; Adult ; Middle Aged ; Intervertebral Disc Displacement/surgery* ; Retrospective Studies ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Diskectomy, Percutaneous/methods* ; Diskectomy/methods* ; Treatment Outcome ; Arthroplasty

OBJECTIVE: To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups, and provide a basis for clinical formulation of precise and individualized treatments. METHODS: A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed, in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤45 years old), middle-aged group(>45 years old and <60 years old) and older group(≥60 years old). Before treatment, 3 days, 1 month and 6 months after treatment, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods. RESULTS: ①VAS and JOA score outcomes, in the same age group and the same treatment method, the VAS and JOA scores at different time points postoperatively were obviously improved (P<0.05). For the same age group and the different treatment methods, the older group had lower VAS and higher JOA scores after PETD than after CN (P<0.05), and there was no significant difference between the young group and middle-aged group (P>0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P>0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1, 6 months after CN treatment(P<0.05). ②△T and ROM outcomes, in the same age group and same treatment method, postoperative △T and ROM at different time points were obviously improved(P<0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P>0.05), there was no significant difference in ROM between young group and middle-aged group(P>0.05), ROM was higher after PETD treatment than after CN treatment(P<0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P>0.05). There was no significant difference in △T between age groups by CN treatment, but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P<0.05). CONCLUSION Both PETD and CN for inclusive LDH have good efficacy, the curative benefit for older patients receiving PETD within 6 months after surgery more than CN, and CN is more appropriate for young and middle-aged patients.
Middle Aged ; Humans ; Aged ; Intervertebral Disc Displacement/surgery* ; Retrospective Studies ; Lumbar Vertebrae/surgery* ; Diskectomy, Percutaneous/methods* ; Treatment Outcome ; Endoscopy/methods* ; Diskectomy/methods*

OBJECTIVETo study the effect of length of cervical anterior fusion on adjacent levels by Biomechanical test.

METHODSSix fresh-frozen human cervical specimens were used in this study. The specimens were tested in flexion, extension, bending and rotation on a spine 3D test system. The specimens were tested intact and then underwent a single-level anterior cervical discectomy and fusion (ACDF) at the C4-5 first, a double-level fusion at the C4-6, and finally extended to triple-level at the C4-7, Based on a hybrid test method. Changes in overall range of motion (ROM), segmental motion and facet joints pressure during flexion, extension, bending and rotation were measured and statistically analyzed.

RESULTSThe overall ROM of the entire spinal construct decreased progressively as the single-level fixation extending to 2-level and 3-level (P < 0.05). A progressive increase in ROM above (C3-4) the fused motion segment units (MSUs) was found during flexion, extension and bending (P < 0.05). In bending and extension, a same result was recorded on the average pressure and max pressure of C3-4 facet joints (P < 0.05).

CONCLUSIONSThis study has demonstrated that the biomechanics at adjacent levels to a cervical spine fusion are altered and that there was progressively increased adjacent segment motion and stress as a single-level ACDF extended to a 3-level fusion, which might lead to the acceleration of adjacent segment degeneration.

Biomechanical Phenomena ; Cadaver ; Cervical Vertebrae ; surgery ; Diskectomy ; methods ; Humans ; Range of Motion, Articular ; Rotation ; Spinal Fusion ; methods

Compared with open surgery, percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation (LDH) has advantages of minamilly invasive, little impact on stability of spine and rapid recovery. However, PTED by transforaminal approach has relatively limited indications and can not completely replace open surgery, due to different location of migrated herniated fragment, the level of pathological segment or presence of a high iliac crest. Development of new approach and ancillary equipment have become the focus and future direction of PTED. In recent years, interlaminar and transiliac approach extended the indications of PTED greatly. However, not-standard manipulation, improper selection of indications or surgical approach has been attributed to the main reason for failure in PTED surgery. In view of this, the paper summaries indications, different approaches and methods, clinical efficacy and complications of PTED.
Diskectomy, Percutaneous ; instrumentation ; methods ; Endoscopy ; methods ; Humans ; Intervertebral Disc Displacement ; complications ; surgery ; Lumbar Vertebrae ; surgery

Arthroplasty, Replacement ; methods ; Diskectomy ; methods ; Humans ; Spinal Diseases ; surgery ; Spine ; surgery

OBJECTIVETo explore applicability and therapeutic effects of Micro-endoscopic discectomy (MED) for the treatment of lumbar disc herniation in senile patients over seventy years old.

METHODSThirty-two patients over seventy years old with lumber disc herniation were treated by MED from December 2007 to June 2010. Among them,20 patients were male and 12 patients were female,ranging in age from 70 to 86 years, with an average of 78.5 years old. The course of diseases ranged from 2 weeks to 30 years, with an average of 3.5 years. The main clinical symptoms were low back pain with radiating pain in lower extremities, especially under the keen joint. The surgical time, blood loss, complications and function recovery were evaluated retrospectively immediately after operation. X-ray at 1 week after operation was used to observe the change of physical curvature of lumbar; MRI at 1 month after operation was used to observe the radiographic change of lumbar before and after treatment; MacNab standard was applied to evaluate the therapeutic effects at 3 months after operation.

RESULTSThe mean follow up period was 12.5 months (from 3 to 30 months). The mean operative time was 60 min (from 30 to 120 min) and the mean blood loss was 45 ml (from 15 to 150 ml). Leakage of cerebrospinal fluid occurred in 1 case, the operation continued after pressing by brain cotton and without nerve root and vessels injury; 1 case aggravated after revive, but other patients were eased. X-ray at 1 week after operation showed physical curvature of lumbar of 25 patients improved; MRI at 1 month after operation showed residue intervertebral disc and calcification tissue in 8 cases. Eleven patients still had numbness of limbs,but the pain and tenderness of limbs relieved. According to MacNab standard at 3 months after operation, 25 cases got an excellent result (78.1%), 6 good (18.8%) and 1 fair (3.1%).

CONCLUSIONMED is effective for the senile patients over 70 years old with lumbar disc herniation and promotes ambulation earlier. MED has the advantage of minimal invasive, less blood loss and good clinical effects; MED is suitable for the patients with obvious radiating pain in lower extremities, especially under the keen joint and combine with mild spinal stenosis and root stenosis.

Aged ; Aged, 80 and over ; Diskectomy ; methods ; Endoscopy ; methods ; Female ; Humans ; Intervertebral Disc Displacement ; pathology ; surgery ; Male

There has been rapid progress in endoscopy-and imaging technology-based minimally invasive surgery for the treatment of lumbar disc herniation (LDH). It is advategeous over conventional surgery in that it not only reduces surgical trauma but relieves sufferings of patients. However, endoscopy-and imaging technology-based minimally invasive surgery cannot completely replace traditional surgery at present because of its limited indications. How to expand the indications and solve the practical problem of lumbar reconstruction remains to be the direction of future breakthrough. This article is a summary of the progress and current situation of minimally invasive percutaneous and endoscopic techniques for the treatment of LDH.
Diskectomy ; methods ; Endoscopy ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Minimally Invasive Surgical Procedures ; methods

The use of anterior surgical techniques for the treatment of adolescent idiopathic scoliosis (AIS) has increased recently and anterior discectomy, anterior release and fusion, instrumentation of the thoracic scoliosis can be performed through a thoracoscopic approach. The thoracoscopic approach has several advantages: small surgical trauma, early return to work, reduced postoperative pain and improved postoperative respiratory functions. Although the thoracoscopic approach still has some shortcomings currently, it will be widely accepted with further development of this technique and instrumentations in the future.
Adolescent ; Animals ; Diskectomy ; methods ; Humans ; Internal Fixators ; Scoliosis ; surgery ; Spinal Fusion ; methods ; Thoracic Vertebrae ; surgery ; Thoracoscopy ; methods ; Thoracotomy ; methods

OBJECTIVETo compare the early clinical effects of Activ C cervical disc replacement (ACDR) and anterior cervical discectomy and fusion (ACDF) in treating single-level cervical spondylosis.

METHODSThe clinical data of 76 patients with single-level cervical spondylosis underwent surgery from July 2009 to September 2012 were retrospectively analyzed. Among them, 28 patients were treated with ACDR (ACDR group), including 18 males and 10 females, aged from 32 to 62 years old with an average of (45.2±6.2) years; and 48 patients were treated with ACDF (ACDF group), including 28 males and 20 females, aged from 33 to 60 years old with an average of (45.8±6.4) years. Visual analogue scale (VAS), Japanese Orthopedics Association (JOA) score, Short Form-36 (SF-36), imaging data were used to assess the clinical effects after operation.

RESULTSA total of 76 patients were followed up from 6 to 24 months with an average of 13.2 months. VAS of neck pain and brachialgia were improved in all patients after operation (P<0.05), there was no significant difference between two group (P>0.05). Somato-score and psycho-score of SF-36 of two groups were obviously increased (P<0.05), ACDR group was better than that of ACDF group (P<0.05). In ACDR group, there was no significant difference in the range of motion of surgical segments and adjacent segments between preoperative and postoperative (P>0.05); heterotopic ossification around the edge of vertebral body occurred in 1 case on the 6th month after operation, no fusion was found on the 1st year after operation. In ACDF group, the adjacent vertebral disease occurred in 1 case and the patient underwent the reoperation.

CONCLUSIONActiv C cervical disc replacement can reduce the degeneration of adjacent segments and its early outcomes for the treatment of single-level cervical spondylosis are satisfactory, but the long-term effects still need study.

Adult ; Cervical Vertebrae ; surgery ; Diskectomy ; methods ; Female ; Humans ; Male ; Middle Aged ; Spinal Fusion ; methods ; Spondylosis ; surgery ; Total Disc Replacement ; methods