OBJECTIVE: To investigate the clinical significance and related factors of drainage tube after percutaneous endoscopic lumbar discectomy(PELD). METHODS: The clinical data of 151 patients with lumbar disc herniation who underwent PELD from January 2019 to September 2019 was retrospectively analyzed. According to whether the drainage tube was used after operation, the patients were divided into drainage tube group and non drainage tube group. The placement time and total drainage volume were recorded. The characteristics of patients, such as age, gender, body mass index, lumbar disc herniation segment, smoking history, basic diseases and whether taking anticoagulants, were analyzed by single factor and multiple factor. RESULTS: Drainage tubes were used in 32 patients after PELD. There were statistical differences in visual analogue scale(VAS) and Japanese Orthopaedic Assiciation(JOA) scores between postoperative and preoperative of that in two groups(P<0.05). There were statistical differences in VAS and JOA scores at discharge between two groups(P<0.05), while there were no statistical differences at other time points(P>0.05). Univariate analysis showed that age, basic diseases and whether taking anticoagulants were related to the use of drainage tube, but gender, body mass index, lumbar disc herniation segment and smoking history were not significantly related to the use of drainage tube. Multivariate analysis showed that elderly patients, complicated with hypertension and diabetes, taking anticoagulants were related to the use of drainage tube. CONCLUSION The use of drainage tube after percutaneous endoscopic lumbar discectomy can improve the symptoms of lumbar and leg pain in early stage. For elderly patients with hypertension, diabetes and taking anticoagulants drugs, drainage tube can be considered after transforaminal endoscopy.
Aged ; Diskectomy/adverse effects* ; Diskectomy, Percutaneous/adverse effects* ; Drainage ; Endoscopy ; Humans ; Intervertebral Disc Displacement/surgery* ; Lumbar Vertebrae/surgery* ; Retrospective Studies ; Treatment Outcome

Diskectomy ; Humans ; Postoperative Complications ; etiology ; Spinal Fusion ; adverse effects ; Spine ; surgery ; Vertebroplasty

Diskectomy ; adverse effects ; instrumentation ; methods ; Endoscopes ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae

Anterior cervical discectomy and fusion (ACDF) has achieved good clinical results since it was used in clinic, and is considered as the gold standard for the treatment of cervical spondylosis. However, more and more attention has been paid to adjacent segment degeneration(ASDeg) after fusion, and the debate about its pathogenesis is mainly focused on the bio-machanical stress changes of adjacent segments caused by fusion and the result of the natural aging process. The occurrence of ASDeg after fusion seriously affect the med-and long-term outcome of surgery, and some patients even need secondary surgery. In order to reduce or even avoid the occurrence of ASDeg, many new techniques have emerged in clinic, such as artificial disc replacement with preservation of motor segments, emerging cell transplantation technology and so on, but the clinical effect still needs to be confirmed by a large number of studies. Therefore, finding the risk factors of ASDeg after fusion is of great significance for fusion surgery on the clinical work. At present, there is still no unified overview of the research on the risk factors of ASDeg. This article will review the research progress and corresponding countermeasures of the risk factors of ASDeg after ACDF, in order to guide the clinical application.
Humans ; Risk Factors ; Diskectomy/adverse effects* ; Total Disc Replacement ; Spondylosis/surgery*

OBJECTIVETo analyze the problems and complications of posterior discectomy for lumbar disc herniation.

METHODSFrom January 2005 to June 2010, 497 patients with lumbar disc herniation were treated by posterior discectomy, which data were analyzed retrospectively. There were 395 males and 102 females,ranging in age from 20 to 78 years with an average of 43.7 years. Among them, 405 cases were in single gap, 86 cases were in double gaps and 6 cases were in three gaps. The complication of operation and solution was analyzed.

RESULTSThe mean operative time was 70 min (from 45 to 210 min), and the mean hospitalization was 10 d (from 5 to 20 d). Forty-seven cases suffered operative complications. There were 16 cases of wrong location of segments (14 cases occurred in operation and 2 occurred after operation), 15 cases of less alleviation or aggravation of nerve symptoms (12 cases were poor alleviation and 3 cases were aggravation), 10 cases of urinary retention, 5 cases of cerebrospinal fluid leakage and 1 case of infection.

CONCLUSIONMinimally invasive process of posterior discectomy in treating lumbar disc herniation may complicate with many problems. The operative effects can be improved and the complication can be decreased if the ability of location is improved,surgical indications is correct and the operation is exactly performed.

Adult ; Aged ; Diskectomy ; adverse effects ; methods ; Female ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Retrospective Studies

Diskectomy, Percutaneous ; adverse effects ; methods ; Endoscopy ; methods ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Minimally Invasive Surgical Procedures ; adverse effects ; methods

BACKGROUND: Neuropathic pain, including paresthesia/dysesthesia in the lower extremities, always develops and remains for at least one month, to variable degrees, after percutaneous endoscopic lumbar discectomy (PELD). The recently discovered dual analgesic mechanisms of action, similar to those of antidepressants and anticonvulsants, enable nefopam (NFP) to treat neuropathic pain. This study was performed to determine whether NFP might reduce the neuropathic pain component of postoperative pain. METHODS: Eighty patients, who underwent PELD due to herniated nucleus pulposus (HNP) at L4-L5, were randomly divided into two equal groups, one receiving NFP (with a mixture of morphine and ketorolac) and the other normal saline (NS) with the same mixture. The number of bolus infusions and the infused volume for 3 days were compared in both groups. The adverse reactions (ADRs) in both groups were recorded and compared. The neuropathic pain symptom inventory (NPSI) score was compared in both groups on postoperative days 1, 3, 7, 30, 60, and 90. RESULTS: The mean attempted number of bolus infusions, and effective infused bolus volume for 3 days was lower in the NFP group for 3 days. The most commonly reported ADRs were nausea, dizziness, and somnolence, in order of frequency in the NFP group. The median NPSI score, and all 5 median sub-scores in the NFP group, were significantly lower than that of the NS group until postoperative day 30. CONCLUSIONS: NFP significantly reduced the neuropathic pain component, including paresthesia/dysesthesia until 1 month after PELD. The common ADRs were nausea, dizziness, somnolence, and ataxia.
Anticonvulsants ; Antidepressive Agents ; Ataxia ; Diskectomy* ; Diskectomy, Percutaneous ; Dizziness ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Infusions, Intravenous ; Intervertebral Disc Displacement ; Lower Extremity ; Morphine ; Nausea ; Nefopam* ; Neuralgia ; Pain, Postoperative ; Paresthesia* ; Symptom Assessment

Vascular injuries in lumbar disc surgery are serious complications which may be overlooked due to a broad range of clinical manifestations. It is important to be aware of the perioperative implications of this rare occurrence to lower mortality risk. A 20-yr-old man with a right L4-5 lumbar disc protrusion was operated on routinely under a surgical microscope. A bloody surgical field was noted temporarily during a discectomy along with a decreased blood pressure. After fluid resuscitation with an ephedrine injection, the bleeding soon stopped spontaneously and his vital signs were stabilized. Fifty hours after the operation, the patient showed signs of hypovolemic hypotension with abdominal distension. The right femoral artery pulsation was absent on palpation. An enhanced CT angiography revealed a retroperitoneal hematoma and obstruction of the left common iliac artery. An urgent laparotomy was done to repair the injured vessel by excision and interposition of a graft. The patient had an uneventful recovery.The subacute course of deterioration might have been due to intermittent blood leakage from the lacerated common iliac artery, which was sealed spontaneously. It is very important to pay close attention to post-surgical clinical manifestations to avoid a potentially fatal outcome in lumbar disc surgery.
Angiography ; Diskectomy/*adverse effects ; Hematoma/etiology ; Humans ; Iliac Artery/*injuries ; Intervertebral Disc ; Lacerations/*etiology ; Lumbar Vertebrae/*surgery ; Male ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo evaluate the outcomes of discectomy with transforaminal endoscope through interlaminar approach in treating lumbar disc herniation.

METHODSFrom April 2009 to April 2010, the clinical data of 27 patients with lumbar disc herniation were retrospectively analyzed. The patients were treated with discectomy by transforaminal endoscope through interlaminar approach, including 20 males and 7 females, with an average age of 41.8 years, ranging from 21 to 69 year; of them, 12 patients with "from inside to outside" approach and 17 patients with "from outside to inside" approach. All the patients were followed up. Clinical effect were evaluated according to Oswestry Disability Index (ODI) and modified MacNab standard.

RESULTSThe operation of one case was stopped because of unobvious visual field of bleeding and the one case was transferred to microendoscopic discectomy. Other operations of 25 cases were successful. Among 27 patients, 20 cases were followed up from 12 to 24 months with an average of (18.0+/-2.5) months. The mean of ODI improved from preoperative (75.4+/-7.8)% to (13.0+/-20.5)% at final follow-up (P=0.000). According to modified MacNab standard, 7 cases obtained excellent result, 9 good, 1 fair and 3 poor. Among the poor outcome, one patient accepted the classical discectomy because of recurrent herniation of same level three months later,and the other two need take medicine.

CONCLUSIONThe discectomy with transforaminal endoscope through interlaminar approach for lumbar disc herniation is effective by decompress through from outside to inside access and from inside to outside access,the former is recommended to the dural sac and nerve root compressed to collateral side by huge protrusion and the latter is recommended to relatively smaller protrusion with long time conservative therapy.

Adult ; Aged ; Diskectomy ; adverse effects ; instrumentation ; methods ; Endoscopes ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged

OBJECTIVETo evaluate mid-term clinical results of microendoscopic discectomy (MED) for the treatment of lumbar disc hermiation.

METHODSIn the study, 117 patients were reviewed,including 63 male and 54 female, ranging in age from 24 to 72 years,with an average of 50.6 years. Among the patients, 60 patients had simple lumbar disc herniation, 10 patients had simple lateral crypt stenosis, 32 patients had lumbar disc herniation combined with lateral crypt stenosis, and 15 patients were combined with calcified nucleus pulposus. Two patients had herniation in L3-L4, 56 patients in L4-L5, 48 patients in L5-S1, 11 patients in L4-L5 and L5-S1. The central type of lumbar disc herniation occurred in 22 patients and the lateral type of herniation occurred in other 95 patients. The Protrusion type of herniation occurred in 32 discs, ruptured type in 73 discs, and free type in 12 discs. Ninety-eight patients had lumbar and leg pain in one side, and 19 patients in double sides. MED was used to remove the nucleus and decompress the nerve root canal.

RESULTSAll the patients were followed up and the duration ranged from 48 to 84 months,with an average of 5.5 years. According to lumbar and leg pain evaluation criteria from spinal group of Chinese Orthopaedic Association, there were 93 patients got an excellent result, 16 good and 8 poor.

CONCLUSIONAppropriate control indications and skillful surgical techniques are the key points to decrease the complication and to improve the curative effect.

Adult ; Aged ; Diskectomy ; adverse effects ; methods ; Endoscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Male ; Middle Aged