Oblique lumbar interbody fusion (OLIF) has been driven to the maturity stage in recent years. However, postoperative symptoms such as thigh paresthesia resulting from intraoperative retraction of the psoas major (PM) have sometimes occurred. The aim of this study was to assess the different positions and morphology of PM muscles and their relationship with clinical outcomes after OLIF by introducing the Moro zones. Patients who underwent L4-5 OLIF at our institution between April 2019 and June 2021 were reviewed and all data were recorded. All patients were grouped by Moro zones into a Moro A cohort and a Moro I and II cohort based on the front edges of their left PM muscles. A total of 94 patients were recruited, including 57 in the Moro A group and 37 in the Moro I and II group. Postoperative thigh pain or numbness occurred in 12 (21.1%) and 2 (5.4%) patients in the Moro A group and the Moro I and II group, respectively. There was no difference in the psoas major transverse diameter (PMTD) between groups preoperatively, while longer PMTD was revealed postoperatively in the Moro A group. The operating window (OW) and psoas major sagittal diameter (PMSD) showed significant differences within and between groups. Thirteen patients had teardrop-shaped PM muscles, with 92.3% in the Moro A group showing significantly worse clinical scores at 1-week follow-up. The Moro zones of the PM affected the short-term outcomes after OLIF. Preoperative measurements and analysis of OW, PMSD and PM morphology should be performed as necessary to predict short-term outcomes.
ObjectiveLocal anesthesia (LA) is recommended for percutaneous transforaminal endoscopic discectomy(PTED), but satisfactory pain management is not mostly achieved. The goal of this study was to examine the clinical efficacy of PTED for lumbar disc herniation when performed under local anaesthetic vs. general anesthesia (GA).MethodsFrom August 2018 to August 2020, the clinical data of 108 patients treated with PTED were retrospectively evaluated and separated into two groups: LA and GA based on the anesthesia method. General information and clinical outcomes of patients were included. Visual analog scale (VAS) and Oswestry disability index (ODI) were recorded before operation, 1 week after operation, and 1 year after operation. In addition, VAS for back pain and leg pain on the second postoperative day were also recorded.ResultsWe divided the patients into two groups: 72 in LA and 36 in GA. There were no significant differences in gender, age, course of disease, body mass index, surgical segment, duration of operation, intraoperative bleeding, time of fluoroscopy, length of hospital stay, total hospitalization cost reoperation, surgical satisfaction, Macnab satisfaction, complications, preoperative and 1 year postoperatively VAS for back pain and leg pain and ODI, VAS for leg pain on the second day and 1 week postoperatively between the two groups (P > 0.05). VAS for back pain in GA group on the second day postoperatively, as well as the VAS for back pain and ODI at one week postoperatively, were better than those in LA group (P < 0.05). However, the total hospitalization cost in LA group was significantly lower than that in GA group (P < 0.05). Further analysis of different ages in the two groups showed that there were significant differences in the VAS for back pain on the second day postoperatively and ODI at 1 week postoperatively in the middle-aged group (45 ≤ Y ≤ 59), as well as the VAS for back pain on the second day postoperatively in the senior group (Y ≥ 60) (P < 0.05). However, there were no significant difference among other groups (P > 0.05).ConclusionLong-term outcomes were similar for both PTED under LA and GA, while GA group had better short-term outcomes, especially in middle-aged and elderly patients.
Background Local anesthesia(LA) is recommended for percutaneous transforaminal endoscopic discectomy(PTED), but satisfactory pain management is not mostly achieved.The goal of this study was to examine the clinical efficacy of PTED for lumbar disc herniation when performed under local anaesthetic versus general anesthesia (GA). Methods From August 2018 to August 2020, the clinical data of 108 patients treated with PTED were evaluated and separated into two groups: LA and GA. General information and clinical outcomes of patients were included. Visual analog scale (VAS) and Oswestry disability index (ODI) were recorded before operation, 1 week after operation, and 1 year after operation. In addition, VAS for back pain and leg pain on the second postoperative day were also recorded. Results We divided the patients into two groups: 72 in LA and 36 in GA. There were no significant differences in gender, age, course of disease, body mass index, surgical segment, duration of operation, intraoperative bleeding, time of fluoroscopy, length of hospital stay, total hospitalization cost reoperation, surgical satisfaction, Macnab satisfaction, complications, preoperative and 1 year postoperatively VAS for back pain and leg pain and ODI,VAS for leg pain on the second day and 1 week postoperatively between the two groups (P༞0.05). VAS for back pain in GA group on the second day postoperatively, as well as the VAS for back pain and ODI at one week postoperatively, were better than those in LA group. (P < 0.05). However, the total hospitalization cost in LA group was significantly lower than that in GA group (P < 0.05). Further analysis of different ages in the two groups showed that there were significant differences in the VAS for back pain on the second day postoperatively and ODI at 1 week postoperatively in the middle-aged group (45 ≤ Y ≤ 59), as well as the VAS for back pain on the second day postoperatively in the senior group (Y ≥ 60) (P < 0.05). However, there were no significant difference among other groups (P > 0.05). Conclusion Long-term outcomes were similar for both PTED under LA and GA, while GA group had better short-term outcomes, especially in middle-aged and elderly patients.
Background: Foraminoplasty is a critical step in percutaneous endoscopic transforaminal discectomy (PETD) for the treatment of lumbar disc herniation (LDH). It is usually performed using trephine under fluoroscopy guidance and is especially suitable for beginners. However, foraminoplasty with trephine may sometimes leave the cut bone in the body and then even cause neural symptoms. We designed a new tool named anchor drill to assist trephine in performing foraminoplasty. The purpose of this study was to evaluate efficacy and safety for combination of trephine with anchor drill in foraminoplasty.Methods: A retrospective review was performed to identify patients with lumbar disc extrusion or sequestration between January 2018 to January 2021 who underwent PETD. Foraminoplasty using trephine alone or trephine combined with anchor drill under fluoroscopy guidance was performed in all surgeries. Duration of foraminoplasty, endoscopic operation time, fluoroscopy time, bone residual incidence after foraminoplasty and perioperative complications were reviewed. Visual analog scale (VAS) and Japanese Orthopedic Association (JOA) scores were assessed before, 1 day, 3 months and 12 months after surgery for all patients.Results: A total of 100 patients were included (55 in combination group, 45 in trephine group). Bone residual incidence after foraminoplasty of combination group was 9.09%, which was significantly lower than that of trephine group with 33.33% (P<0.05). Mean endoscopic operation time of combination group was significantly shorter than that of trephine group (P<0.05). Fluoroscopy time and duration of foraminoplasty showed no significant differences between two cohorts. Total perioperative complication incidence was lower in combination group, among which the neural irritation incidence showed significant difference (combination group: 3.64%, trephine group: 17.78%, P<0.05). No severe vascular and neurological complications occurred in perioperative period. VAS and JOA scores were compared before and after surgery and differences were statistically significant for all patients (P<0.001). At each follow-up visit, no significant differences were found in VAS and JOA scores between two cohorts. Conclusions: Combination of trephine with anchor drill was demonstrated to be safe and effective in foraminoplasty in PETD, improving success rate of foraminoplasty and reducing neurological complications relative to using trephine alone.
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