ObjectiveThe aim of this study was to compare the curative effect between minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and the posterior lumbar interbody fusion (PLIF) in obese patients with lumbar disk prolapse.Patients and methodsIn this study, 72 patients who underwent lumbar disk prolapse therapy in the Third Hospital of Hebei Medical University between March 2011 and 2015 were retrospectively analyzed and were divided into two groups, MIS-TLIF group (n=35) and PLIF group (n=37), according to different surgical procedures. Several clinical parameters were compared between these two groups.ResultsCompared with PLIF, MIS-TLIF was associated with longer operative time, less blood loss, less postoperative drainage and shorter postoperative time in bed; moreover, patients in the MIS-TLIF group had lower levels of serum creatine kinase on 1, 3 and 5 postoperative days. At the 3- and 6-month follow-up, Visual Analog Scale (VAS) scores of low back pain of patients in the MIS-TLIF group were significantly reduced and Japanese Orthopaedic Association (JOA) scores were increased, whereas the Oswestry Disability Index (ODI) showed no significant difference between the two groups.ConclusionObese patients can achieve good efficacy with MIS-TLIF or PLIF treatment, but MIS-TLIF surgery showed longer operative time, fewer traumas and bleeding volume, less incidence of short-term pain, low complication rate and faster postoperative recovery.

BackgroundVery few studies have discussed transforaminal endoscopic discectomy (TED) in the treatment of common peroneal nerve paralysis induced by lumbar disk herniation (LDH). This study aimed to evaluate the efficacy of TED in the treatment of LDH combined with common peroneal nerve paralysis.Materials and methodsThe clinical and follow-up data of 32 patients with common peroneal nerve paralysis induced by LDH undergoing TED from March 2011 to April 2014 were retrospectively analyzed in this study. Follow-up was conducted immediately after the surgery, as well as 3, 12, and 24 months postoperatively. The parameters (including muscle strength recovery of the anterior tibial muscle, leg pain visual analog scale score, neurological function Japanese Orthopaedic Association [JOA] score, MacNab scores in the last follow-up, and the intraoperative and postoperative complications) were recorded.ResultsThree patients (9.4%) had the anterior tibial muscle strength recovered to ≥ grade 4 immediately after the surgery. The anterior tibial muscle strength of patients recovered to basically stable form in the 6-month postoperative follow-up and that in the last follow-up were as follows: one case of grade 1, one case of grade 2, 28 cases of grade 4, and two cases of grade 5. The visual analog scale scores of leg pain were significantly reduced immediately after the surgery and also on 3, 12, and 24 months compared with preoperative period (all P<0.05). The postoperative JOA scores in the last follow-up were significantly higher than the preoperative JOA scores (P<0.05), and there were nine excellent cases (28.2%), 21 good cases (65.6%), one fair case (3.1%) and one poor case (3.1%) in the last follow-up, with an overall excellent and good rate of 93.8%.ConclusionTED, which can offer sufficient decompression of the nerve root, has excellent overall clinical effects in treating common peroneal nerve paralysis induced by LDH.

No researchers reported Vitamin D could protect degeneration of intervertebral disc. That is to say, we found a new method to prevent and treat degenerative changes of the intervertebral disc in diabetic patients. And Vitamin D prevented the discs by improving the content of TGF-b and IGF-1. AbstractObjective: The contents of transforming growth factor-b and insulin-like growth factor-1 in disc of diabetic rats were measured at three different periods after injected with 1,25-Dihydroxyvitamin D3, and compared with that in normal rats. The significance of content changes was also discussed. Methods: Fourty-five Sprague-Dawley (SD) rats were divided into three groups, namely the experimental group (STZþcalcitriol), control group (STZþcitrate buffer), and normal group (citrate buffer). Complete lumbar discs in these groups were obtained at the second, fourth, sixth week, respectively. After paraffin-embedded sections and HE staining, the structure and morphology changes of disc were observed. The content of transforming growth factor-b and insulin-like growth factor-1 was measured by immunohistochemical method, and the expression of transforming growth factor-b and insulin-like growth factor-1 was detected by Western Blot. Results: In hematoxylin-eosin staining, degenerative changes were observed in disc of experimental and control group at three different periods, and there were no changes in disc in normal group. Immunohistochemical method indicated the content of transforming growth factor-b and insulin-like growth factor-1 in experimental and control group was significantly lower than normal group at three different periods (P < 0.05). And there were significant differences between experimental and control group at three different periods (P < 0.05). Conclusion: Vitamin D can protect the degeneration of intervertebral disc and improve the content of transforming growth factorb and insulin-like growth factor-1 in the intervertebral disc, which provides a new idea for the prevention and treatment of degenerative changes of the intervertebral disc in diabetic patients.

The aim of our study was to explore risk factors of cage nonunion after anterior cervical discectomy and fusion (ACDF). 295 patients underwent ACDF in our hospital between Jan. 2014 and Jan. 2017. Of them, 277 patients suffered cage union (union group, UG) after 6-month follow-up and 18 did not (nonunion group, NG). We collected possible factors including gender, history of smoking, alcohol, hypertension, heart disease, diabetes, body mass index, diagnose, and preoperative visual analog scale -neck, visual analog scale-arm, neck disability index (NDI) and Japanese Orthorpaedic Association, surgical duration, blood loss, fusion levels, superior fusion segment, angle of C2–C7, range of motion for C2–C7, C2–C7 sagittal vertical axis and T1 slope. We performed univariable and multivariable analysis to compare data in 2 groups. The rate of cage nonunion after ACDF was 6.1% (18 of 295) in our study. The outcome of univariable analysis showed that age (63.5 ± 10.1), angle of C2–C7 (18.0 ± 4.6), range of motion of C2–C7 (32.5 ± 7.7), C2–C7 sagittal vertical axis (17.9 ± 4.3) and T1 slope (22.1 ± 5.3) were higher in NG than these (59.4 ± 9.2, 16.2 ± 4.5, 30.2 ± 6.9,16.1 ± 4.0, 20.9 ± 4.9) in UG. Additionally, patients with osteoporosis had markedly higher rate of cage nonunion after ACDF than those without. What's more, the multivariable analysis implied the same results with univariable analysis. Many factors could predict cage nonunion after ACDF. Cervical sagittal parameters play an important role in cage nonunion after ACDF. We hope that we can provide some guidance for spine surgeon before performing ACDF.

ObjectiveTo discuss the significance and the short-term effect of bone puncture technique in transiliac approach to intervertebral endoscopic discectomy for the treatment of L5/S1 intervertebral disc herniation.MethodsNineteen patients were diagnosed as L5/S1 disc herniation and treated using transiliac approach to endoscopic discectomy (group I), and 20 patients were diagnosed as non-L5/S1 disc herniation and underwent conventional approach (group R). Leg pain was evaluated by VAS. MacNab ratings of the last follow-up were recorded to evaluate early clinical efficacy, and postoperative complications were recorded to evaluate surgical safety. The imaging changes of the patients 3 months after surgery were observed.ResultsOne patient in group I, who felt abnormal in nerve roots, underwent symptomatic treatments, such as rehydration and hormone, and the abnormalities disappeared 3 days after treatment. There were no significant significances in operative time and intraoperative fluoroscopy times between groups I and R (p > 0.05), but there was a higher tendency in group I. The VAS scores of post-operation were significantly lower than that of pre-operation in the two groups (p < 0.05), but there were no significant differences between the two groups (p > 0.05). The MacNab score of the last follow-up showed excellent rate (95%) and good rate (90%) in groups I and R, respectively.ConclusionsBone puncture-combined transiliac approach to intervertebral endoscopic surgery could locate iliac puncture point individually, and establish a good iliac channel, which is safe, effective, and minimally invasive.

BackgroundThis study aimed to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in the treatment of obese patients with lumbar disc herniation (LDH).Material/MethodsA total of 69 obese patients with LDH (35 males and 34 females; age range, 24 to 43 years; median age, 34 years) were included in this study. These patients had undergone TED from March 2011 to December 2015 in the Third Hospital of Hebei Medical University. Their clinical and follow-up data were prospectively analyzed. The degree of pain and disability were measured on the basis of the Visual Analog Scale (VAS) at 1 day before surgery, immediately after surgery, and 3 months after surgery. Neurologic functions were measured on the basis of the Japanese Orthopaedic Association (JOA) system 1 day before surgery and 3 months after surgery. The MacNab score at last follow-up was recorded to evaluate the early clinical efficacy. Complications during and after the operation were recorded to evaluate the safety of surgery.ResultsTwo patients experienced abnormal sensations in the export nerve root zone postoperatively, which disappeared after 3 days of treatment with dehydration and administration of hormone (dexamethasone). Three cases of recurrence were observed at 6 months, 7 months, and 9 months postoperatively; they were scheduled to receive total laminectomy combined with bone grafting internal fixation. A total of 67 patients were followed up for 3–23 months and mean follow-up was 11.8 months. The VAS scores at postoperative 3 months and 1 year were significantly reduced compared to that before the operation, with significant differences between them (t=43.072, P<0.05; t=43.139, P<0.05). The JOA scores at last follow-up postoperatively was significantly higher than that before surgery (t=−60.312, P<0.05). At the last follow-up, 17 cases (25.3%) had excellent outcomes, 39 (58.2%) good, 7 (10.4%) fair, and 4 (5.9%) poor. Overall, 83.5% of patients had excellent or good rates.ConclusionsThe early efficacy of TED is relatively good and safe for the selected obese patients with LDH in this study. Larger-sample studies with longer duration and follow-up are required to detect the safety and effectiveness of TED.

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