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Commentary on “Navigation-Guided/Robot-Assisted Spinal Surgery: A Review Article” 关于 "导航引导/机器人辅助脊柱手术 "的评论文章：评论文章"

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 DOI: 10.14245/ns.2448256.128

John R. Adler Jr

引用次数: 0

From the Editor-in-Chief: Featured Articles in the March 2024 Issue. 主编的话2024 年 3 月刊的特色文章。

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 Epub Date: 2024-03-31 DOI: 10.14245/ns.2448218.109

Inbo Han

引用次数: 0

Proteoglycan Dysfunction: A Common Link Between Intervertebral Disc Degeneration and Skeletal Dysplasia 蛋白多糖功能障碍：椎间盘退变与骨骼发育不良之间的共同联系

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 DOI: 10.14245/ns.2347342.671

Kimheak Sao, M. Risbud

Proteoglycans through their sulfated glycosaminoglycans regulate cell-matrix signaling during tissue development, regeneration, and degeneration processes. Large extracellular proteoglycans such as aggrecan, versican, and perlecan are especially important for the structural integrity of the intervertebral disc and cartilage during development. In these tissues, proteoglycans are responsible for hydration, joint flexibility, and the absorption of mechanical loads. Loss or reduction of these molecules can lead to disc degeneration and skeletal dysplasia, evident from loss of disc height or defects in skeletal development respectively. In this review, we discuss the common proteoglycans found in the disc and cartilage and elaborate on various murine models and skeletal dysplasias in humans to highlight how their absence and/or aberrant expression causes accelerated disc degeneration and developmental defects.

在组织发育、再生和退化过程中，蛋白聚糖通过硫酸化的糖胺聚糖调节细胞与基质之间的信号传递。大型细胞外蛋白聚糖（如 aggrecan、versican 和 perlecan）对椎间盘和软骨在发育过程中的结构完整性尤为重要。在这些组织中，蛋白聚糖负责水合作用、关节灵活性和吸收机械负荷。这些分子的缺失或减少可导致椎间盘退化和骨骼发育不良，分别表现为椎间盘高度下降或骨骼发育缺陷。在这篇综述中，我们将讨论在椎间盘和软骨中发现的常见蛋白多糖，并详细阐述各种小鼠模型和人类骨骼发育不良症，以突出它们的缺失和/或异常表达是如何导致椎间盘加速退化和发育缺陷的。

引用次数: 1

Commentary on “Clinical Characteristics, Surgical Outcomes, and Risk Factors for Emergency Surgery in Patients With Spinal Metastases: A Prospective Cohort Study” 关于 "脊柱转移瘤患者的临床特征、手术结果和急诊手术风险因素 "的评论：一项前瞻性队列研究

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 DOI: 10.14245/ns.2448238.119

John H. Chi

for

对于

引用次数: 0

Prognostic Value in Preoperative Veterans RAND-12 Mental Component Score on Clinical Outcomes for Patients Undergoing Minimally Invasive Lateral Lumbar Interbody Fusion. 术前退伍军人 RAND-12 心理成分评分对微创侧腰椎椎间融合术患者临床结果的预后价值。

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 Epub Date: 2024-01-29 DOI: 10.14245/ns.2346730.365

Ishan Khosla, Fatima N Anwar, Andrea M Roca, Srinath S Medakkar, Alexandra C Loya, Keith R MacGregor, Omolabake O Oyetayo, Eileen Zheng, Aayush Kaul, Jacob C Wolf, Vincent P Federico, Gregory D Lopez, Arash J Sayari, Kern Singh

Objective: To evaluate the effect of Veterans RAND 12-item health survey mental composite score (VR-12 MCS) on postoperative patient-reported outcome measures (PROMs) after undergoing lateral lumbar interbody fusion.

Methods: Retrospective data from a single-surgeon database created 2 cohorts: patients with VR-12 MCS ≥ 50 or VR-12 MCS < 50. Preoperative, 6-week, and final follow-up (FF)- PROMs including VR-12 MCS/physical composite score (PCS), 12-item Short Form health survey (SF-12) MCS/PCS, Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), Patient Health Questionnaire-9 (PHQ-9), visual analogue scale (VAS)-back/leg pain (VAS-BP/LP), and Oswestry Disability Index (ODI) were collected. ∆6-week and ∆FF-PROMs were calculated. Minimal clinically important difference (MCID) achievement rates were determined from established cutoffs from the literature. For intercohort comparison, chi-square analysis was used for categorical variables, and Student t-test for continuous variables.

Results: Seventy-nine patients were included; 25 were in VR-12 MCS < 50. Mean postoperative follow-up time was 17.12 ± 8.43 months. The VR-12 MCS < 50 cohort had worse VR-12 PCS, SF-12 MCS, PROMIS-PF, PHQ-9, VAS-BP, and ODI scores preoperatively (p ≤ 0.014, all), worse VR-12 MCS/PCS, SF-12 MCS, PROMIS-PF, PHQ-9, and ODI scores at 6-week postoperatively (p ≤ 0.039, all), and worse VR-12 MCS, SF-12 MCS, PROMIS-PF, PHQ-9, VAS-BP, VAS-LP, and ODI scores at FF (p ≤ 0.046, all). The VR-12 MCS < 50 cohort showed greater improvement in VR-12 MCS and SF-12 MCS scores at 6 weeks and FF (p ≤ 0.005, all). The VR-12 MCS < 50 cohort experienced greater MCID achievement for VR-12 MCS, SF-12 MCS, and PHQ-9 (p ≤ 0.006, all).

Conclusion: VR-12 MCS < 50 yielded worse mental health, physical function, pain and disability postoperatively, yet reported greater improvements in magnitude and MCID achievement for mental health.

目的评估VR-12 MCS对LLIF术后患者报告结果指标（PROMs）的影响：来自单个外科医生数据库的回顾性数据创建了两个队列：VR-12 MCS ≥50或VR-12 MCS的患者：共纳入 79 例患者，其中 25 例为 VR-12 MCS：VR-12 MCS

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引用次数: 0

Is Direct Decompression Necessary for Lateral Lumbar Interbody Fusion (LLIF)? A Randomized Controlled Trial Comparing Direct and Indirect Decompression With LLIF in Selected Patients 外侧腰椎椎间融合术（LLIF）是否需要直接减压？一项随机对照试验，比较直接减压和间接减压与 LLIF 在部分患者中的应用

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 DOI: 10.14245/ns.2346906.453

Worawat Limthongkul, Chayapong Thanapura, Khanathip Jitpakdee, Pakawas Praisarnti, Vit Kotheeranurak, Wicharn Yingsakmongkol, Teerachat Tanasansomboon, Weerasak Singhatanadgige

Objective To compare the clinical and radiographic outcomes following lateral lumbar interbody fusion (LLIF) between direct and indirect decompression in the treatment of patients with degenerative lumbar diseases. Methods Patients who underwent single-level LLIF were randomized into 2 groups: direct decompression (group D) and indirect decompression (group I). Clinical outcomes including the Oswestry Disability index and visual analogue scale of back and leg pain were collected. Radiographic outcomes including cross-sectional area (CSA) of thecal sac, disc height, foraminal height, foraminal area, fusion rate, segmental, and lumbar lordosis were measured. Results Twenty-eight patients who met the inclusion criteria were eligible for the analysis, with a distribution of 14 subjects in each group. The average age was 66.1 years. Postoperatively, significant improvements were observed in all clinical parameters. However, these improvements did not show significant difference between both groups at all follow-up periods. All radiographic outcomes were not different between both groups, except for the increase in CSA which was significantly greater in group D (77.73 ± 20.26 mm2 vs. 54.32 ± 35.70 mm2, p = 0.042). Group I demonstrated significantly lower blood loss (68.13 ± 32.06 mL vs. 210.00 ± 110.05 mL, p < 0.005), as well as shorter operative time (136.35 ± 28.07 minutes vs. 182.18 ± 42.67 minutes, p = 0.002). Overall complication rate was not different. Conclusion Indirect decompression through LLIF results in comparable clinical improvement to LLIF with additional direct decompression over 1-year follow-up period. These findings suggest that, for an appropriate candidate, direct decompression in LLIF might not be necessary since the ligamentotaxis effect achieved through indirect decompression appears sufficient to relieve symptoms while diminishing blood loss and operative time.

目的比较直接减压和间接减压治疗腰椎退行性疾病患者侧腰椎椎间融合术（LLIF）后的临床和影像学效果。方法将接受单水平 LLIF 的患者随机分为两组：直接减压组（D 组）和间接减压组（I 组）。收集临床结果，包括 Oswestry 失能指数和腰腿痛视觉模拟量表。放射学结果包括椎间盘囊横截面积（CSA）、椎间盘高度、椎间孔高度、椎间孔面积、融合率、节段和腰椎前凸。结果符合纳入标准的 28 名患者符合分析条件，每组 14 人。平均年龄为 66.1 岁。术后，所有临床参数均有明显改善。不过，在所有随访期间，两组患者的改善情况均无明显差异。两组的所有影像学结果均无差异，只有 D 组的 CSA 增加明显（77.73 ± 20.26 mm2 对 54.32 ± 35.70 mm2，P = 0.042）。I 组的失血量明显更少（68.13 ± 32.06 mL vs 210.00 ± 110.05 mL，p < 0.005），手术时间也更短（136.35 ± 28.07 分钟 vs 182.18 ± 42.67 分钟，p = 0.002）。总体并发症发生率没有差异。结论 LLIF间接减压术与LLIF直接减压术在1年随访期内的临床改善效果相当。这些研究结果表明，对于合适的患者，LLIF 可能不需要直接减压，因为通过间接减压达到的韧带松弛效果似乎足以缓解症状，同时减少失血量和手术时间。

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引用次数: 0

Deep Learning-Enhanced Hand Grip and Release Test for Degenerative Cervical Myelopathy: Shortening Assessment Duration to 6 Seconds 针对颈椎退行性病变的深度学习增强型手部握力和释放测试：将评估时间缩短至 6 秒钟

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 DOI: 10.14245/ns.2347326.663

Yongyu Ye, Yunbing Chang, Weihao Wu, Tianying Liao, Tao Yu, Chong Chen, Zhengran Yu, Junying Chen, G. Liang

Objective Hand clumsiness and reduced hand dexterity can signal early signs of degenerative cervical myelopathy (DCM). While the 10-second grip and release (10-s G&R) test is a common clinical tool for evaluating hand function, a more accessible method is warranted. This study explores the use of deep learning-enhanced hand grip and release test (DL-HGRT) for predicting DCM and evaluates its capability to reduce the duration of the 10-s G&R test. Methods The retrospective study included 508 DCM patients and 1,194 control subjects. Propensity score matching (PSM) was utilized to minimize the confounding effects related to age and sex. Videos of the 10-s G&R test were captured using a smartphone application. The 3D-MobileNetV2 was utilized for analysis, generating a series of parameters. Additionally, receiver operating characteristic curves were employed to assess the performance of the 10-s G&R test in predicting DCM and to evaluate the effectiveness of a shortened testing duration. Results Patients with DCM exhibited impairments in most 10-s G&R test parameters. Before PSM, the number of cycles achieved the best diagnostic performance (area under the curve [AUC], 0.85; sensitivity, 80.12%; specificity, 74.29% at 20 cycles), followed by average grip time. Following PSM for age and gender, the AUC remained above 0.80. The average grip time achieved the highest AUC of 0.83 after 6 seconds, plateauing with no significant improvement in extending the duration to 10 seconds, indicating that 6 seconds is an adequate timeframe to efficiently evaluate hand motor dysfunction in DCM based on DL-HGRT. Conclusion DL-HGRT demonstrates potential as a promising supplementary tool for predicting DCM. Notably, a testing duration of 6 seconds appears to be sufficient for accurate assessment, enhancing the test more feasible and practical without compromising diagnostic performance.

目的手部笨拙和手部灵活性降低可能是颈椎退行性脊髓病（DCM）的早期信号。虽然 10 秒钟握力和释放（10 秒钟 G&R）测试是评估手部功能的常用临床工具，但仍需要一种更方便的方法。本研究探讨了深度学习增强型手部握力和松力测试（DL-HGRT）在预测 DCM 方面的应用，并评估了其缩短 10 秒握力和松力测试时间的能力。方法该回顾性研究包括 508 名 DCM 患者和 1,194 名对照组受试者。研究采用倾向得分匹配法（PSM），以尽量减少与年龄和性别相关的混杂效应。使用智能手机应用程序采集了 10 秒钟 G&R 测试的视频。利用 3D-MobileNetV2 进行分析，生成了一系列参数。此外，还利用接收器操作特征曲线来评估 10 秒 G&R 测试在预测 DCM 方面的性能，并评估缩短测试时间的有效性。结果 DCM 患者的大多数 10 秒 G&R 测试参数都出现了障碍。在 PSM 之前，循环次数的诊断效果最好（曲线下面积 [AUC]，0.85；灵敏度，80.12%；特异性，74.29%，20 个循环），其次是平均握力时间。对年龄和性别进行 PSM 后，AUC 仍保持在 0.80 以上。平均握力时间在 6 秒后达到最高的 AUC，为 0.83，在持续时间延长到 10 秒后趋于平稳，没有明显改善，这表明 6 秒是基于 DL-HGRT 有效评估 DCM 手部运动功能障碍的适当时间范围。结论 DL-HGRT 具有作为预测 DCM 的辅助工具的潜力。值得注意的是，6 秒钟的测试时间似乎足以进行准确评估，从而在不影响诊断效果的情况下提高了测试的可行性和实用性。

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引用次数: 0

The Efficacy of Cervical Pedicle Screw Is Enhanced When Used With 5.5-mm Rods for Metastatic Cervical Spinal Tumor Surgery. 在转移性颈椎肿瘤手术中，颈椎椎弓根螺钉与 5.5 毫米杆配合使用可提高疗效。

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 Epub Date: 2024-01-29 DOI: 10.14245/ns.2346778.389

Danbi Park, Sang Hyub Lee, Subum Lee, Jemin Park, Hyeon Gyu Yang, Chongman Kim, Jin Hoon Park

Objective: The cervical spine presents challenges in treating metastatic cervical spinal tumors (MCSTs). Although the efficacy of cervical pedicle screw placement (CPS) has been well established, its use in combination with 5.5-mm rods for MCST has not been reported. This study aimed to evaluate the efficacy of CPS combined with 5.5-mm rods in treating MCST and compare it with that of CPS combined with traditional 3.5-mm rods.

Methods: This retrospective study analyzed 58 patients with MCST who underwent posterior cervical spinal fusion surgery by a single surgeon between March 2012 and December 2022. Data included demographics, surgical details, imaging results, numerical rating scale score for neck pain, Eastern Cooperative Oncology Group performance status, and Spine Oncology Study Group Outcomes Questionnaire responses.

Results: Preoperative Spinal Instability Neoplastic Scores were significantly higher in the 5.5-mm rod group. Greater kyphotic changes in the index vertebra were observed in the 3.5-mm rod group. Neck pain reduction was significantly better in the 5.5-mm rod group.

Conclusion: CPS with 5.5-mm rods provides superior biomechanical stability and effectively resists forward bending momentum in posterior MCST fusion surgery. These findings support the use of 5.5-mm rods to enhance surgical outcomes.

目的：颈椎是治疗转移性颈椎肿瘤（MCST）的难题。尽管颈椎椎弓根螺钉置入术（CPS）的疗效已得到公认，但将其与 5.5 毫米螺纹杆联合用于 MCST 的报道却寥寥无几。本研究旨在评估 CPS 与 5.5 毫米杆联合治疗 MCST 的疗效，并与 CPS 与传统 3.5 毫米杆联合治疗 MCST 的疗效进行比较：这项回顾性研究分析了2012年3月至2022年12月期间由一名外科医生实施后路颈椎融合手术的58例MCST患者。数据包括人口统计学、手术细节、影像学结果、颈部疼痛数字评分量表得分、东部合作肿瘤学组表现状态以及脊柱肿瘤学研究组结果问卷调查结果：结果：5.5 毫米棒组的术前脊柱不稳定性肿瘤评分明显更高。在 3.5 毫米棒组观察到指数椎体有更大的畸形改变。5.5毫米杆组的颈痛减轻效果明显更好：结论：在 MCST 后路融合手术中，使用 5.5 mm 杆件的 CPS 具有卓越的生物力学稳定性，并能有效抵抗前屈动力。这些研究结果支持使用 5.5 mm 杆件来提高手术效果。

{"title":"The Efficacy of Cervical Pedicle Screw Is Enhanced When Used With 5.5-mm Rods for Metastatic Cervical Spinal Tumor Surgery.","authors":"Danbi Park, Sang Hyub Lee, Subum Lee, Jemin Park, Hyeon Gyu Yang, Chongman Kim, Jin Hoon Park","doi":"10.14245/ns.2346778.389","DOIUrl":"10.14245/ns.2346778.389","url":null,"abstract":"Objective: The cervical spine presents challenges in treating metastatic cervical spinal tumors (MCSTs). Although the efficacy of cervical pedicle screw placement (CPS) has been well established, its use in combination with 5.5-mm rods for MCST has not been reported. This study aimed to evaluate the efficacy of CPS combined with 5.5-mm rods in treating MCST and compare it with that of CPS combined with traditional 3.5-mm rods.Methods: This retrospective study analyzed 58 patients with MCST who underwent posterior cervical spinal fusion surgery by a single surgeon between March 2012 and December 2022. Data included demographics, surgical details, imaging results, numerical rating scale score for neck pain, Eastern Cooperative Oncology Group performance status, and Spine Oncology Study Group Outcomes Questionnaire responses.Results: Preoperative Spinal Instability Neoplastic Scores were significantly higher in the 5.5-mm rod group. Greater kyphotic changes in the index vertebra were observed in the 3.5-mm rod group. Neck pain reduction was significantly better in the 5.5-mm rod group.Conclusion: CPS with 5.5-mm rods provides superior biomechanical stability and effectively resists forward bending momentum in posterior MCST fusion surgery. These findings support the use of 5.5-mm rods to enhance surgical outcomes.","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10992656/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139642670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparing Outcomes of Banana-Shaped and Straight Cages in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis. 比较经椎间孔腰椎椎体间融合术治疗腰椎退行性疾病中香蕉型和直型固定架的疗效：系统回顾与元分析》。

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 Epub Date: 2024-01-31 DOI: 10.14245/ns.2347078.539

Guang-Xun Lin, Li-Ru He, Jin-Niang Nan, Wen-Bin Xu, Keyi Xiao, Zhiqiang Que, Shang-Wun Jhang, Chien-Min Chen, Ming-Tao Zhu, Gang Rui

Objective: This meta-analysis aims to refine the understanding of the optimal choice between different cage shapes in transforaminal lumbar interbody fusion (TLIF) by systematically comparing perioperative data, radiological outcomes, clinical results, and complications associated with banana-shaped and straight bullet cages.

Methods: A meticulous literature search encompassing PubMed, Embase, Scopus, Web of Science, China Knowledge Network, and Wanfang Data was executed up to October 5, 2023. Inclusion criteria focused on studies comparing banana-shaped and straight bullet cages in TLIF. The quality of included studies was assessed using appropriate tools such as the Newcastle-Ottawa Scale (NOS) for nonrandomized studies. Rigorous evaluations were performed for radiographic outcomes, including disc height (DH), segmental lordosis (SL), lumbar lordosis (LL), subsidence, and fusion rates. Clinical outcomes were meticulously evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), and complications.

Results: The analysis incorporated 7 studies, involving 573 patients (297 with banana-shaped cages, 276 with straight cages), all with NOS ratings exceeding 5 stars. No statistically significant differences were observed in operative time, blood loss, or hospitalization between the 2 cage shapes. Banana-shaped cages exhibited greater changes in DH (p = 0.001), SL (p = 0.02), and LL (p = 0.01). Despite statistically higher changes in ODI for straight cages (26.33, p < 0.0001), the actual value remained similar to banana-shaped cages (26.15). Both cage types demonstrated similar efficacy in VAS, complication rates, subsidence, and fusion rates.

Conclusion: Although banana-shaped cages can excel in restoring DH, SL, and LL, straight bullet cages can provide comparable functional improvements, pain relief, and complication rates.

目的：本荟萃分析旨在通过系统比较香蕉型和直球型椎间融合器的围手术期数据、放射学结果、临床效果以及相关并发症，进一步了解经椎间孔腰椎间盘融合术（TLIF）中不同形状椎笼的最佳选择：截至 2023 年 10 月 5 日，对 PubMed、Embase、Scopus、Web of Science、中国知网和万方数据进行了细致的文献检索。纳入标准主要是比较 TLIF 中香蕉型和直球笼的研究。对于非随机研究，采用纽卡斯尔-渥太华量表（NOS）等适当工具对纳入研究的质量进行评估。对放射学结果进行了严格评估，包括椎间盘高度、节段前凸、腰椎前凸、下陷和融合率。使用视觉模拟量表（VAS）、Oswestry 失能指数（ODI）和并发症对临床结果进行了细致的评估：分析纳入了七项研究，涉及 573 名患者（297 名患者使用香蕉型椎笼，276 名患者使用直线型椎笼），所有研究的 NOS 评级均超过 5 星级。两种形状的手术笼在手术时间、失血量或住院时间上没有明显的统计学差异。香蕉型椎板笼在椎间盘高度（P=0.001）、节段前凸（P=0.02）和腰椎前凸（P=0.01）方面的变化更大。尽管香蕉型椎间孔镜能很好地恢复椎间盘高度、节段前凸和腰椎前凸，但直弹型椎间孔镜也能提供类似的功能改善、疼痛缓解和并发症发生率。

{"title":"Comparing Outcomes of Banana-Shaped and Straight Cages in Transforaminal Lumbar Interbody Fusion for Lumbar Degenerative Diseases: A Systematic Review and Meta-Analysis.","authors":"Guang-Xun Lin, Li-Ru He, Jin-Niang Nan, Wen-Bin Xu, Keyi Xiao, Zhiqiang Que, Shang-Wun Jhang, Chien-Min Chen, Ming-Tao Zhu, Gang Rui","doi":"10.14245/ns.2347078.539","DOIUrl":"10.14245/ns.2347078.539","url":null,"abstract":"Objective: This meta-analysis aims to refine the understanding of the optimal choice between different cage shapes in transforaminal lumbar interbody fusion (TLIF) by systematically comparing perioperative data, radiological outcomes, clinical results, and complications associated with banana-shaped and straight bullet cages.Methods: A meticulous literature search encompassing PubMed, Embase, Scopus, Web of Science, China Knowledge Network, and Wanfang Data was executed up to October 5, 2023. Inclusion criteria focused on studies comparing banana-shaped and straight bullet cages in TLIF. The quality of included studies was assessed using appropriate tools such as the Newcastle-Ottawa Scale (NOS) for nonrandomized studies. Rigorous evaluations were performed for radiographic outcomes, including disc height (DH), segmental lordosis (SL), lumbar lordosis (LL), subsidence, and fusion rates. Clinical outcomes were meticulously evaluated using visual analogue scale (VAS), Oswestry Disability Index (ODI), and complications.Results: The analysis incorporated 7 studies, involving 573 patients (297 with banana-shaped cages, 276 with straight cages), all with NOS ratings exceeding 5 stars. No statistically significant differences were observed in operative time, blood loss, or hospitalization between the 2 cage shapes. Banana-shaped cages exhibited greater changes in DH (p = 0.001), SL (p = 0.02), and LL (p = 0.01). Despite statistically higher changes in ODI for straight cages (26.33, p < 0.0001), the actual value remained similar to banana-shaped cages (26.15). Both cage types demonstrated similar efficacy in VAS, complication rates, subsidence, and fusion rates.Conclusion: Although banana-shaped cages can excel in restoring DH, SL, and LL, straight bullet cages can provide comparable functional improvements, pain relief, and complication rates.","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10992667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139692539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years. 经椎间孔内窥镜腰椎间盘切除术与显微椎间盘切除术的临床和影像学效果比较：超过五年的随访。

IF 3.2 2区医学 Q1 Medicine

Neurospine

Pub Date : 2024-03-01 Epub Date: 2024-02-01 DOI: 10.14245/ns.2347026.513

Xinyu Yang, Shijun Zhang, Junxiao Su, Sai Guo, Yakubu Ibrahim, Kai Zhang, Yonghao Tian, Lianlei Wang, Suomao Yuan, Xinyu Liu

Objective: To compare the long-term clinical and radiographic outcomes of transforaminal endoscopic lumbar discectomy (TELD) versus microdiscectomy (MD).

Methods: The data of 154 patients with lumbar disc herniation (LDH) who underwent TELD (n = 89) or MD (n = 65) were retrospectively analyzed. The patients' clinical outcomes were evaluated using visual analogue scales for leg and low back pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI). The evolution of radiographic manifestations was observed during follow-up. Potential risk factors for a poor clinical outcome were investigated.

Results: During a mean follow-up of 5.5 years (range, 5-7 years), the recurrence rate was 4.49% in the TELD group and 1.54% in the MD group. All scores significantly improved from preoperatively to postoperatively in both groups (p < 0.01). The improvement in the ODI and JOA scores was significantly greater in the TELD than MD group (p < 0.05). Forty-seven patients (52.8%) in the TELD group and 32 (49.2%) in the MD group had Modic changes before surgery, most of which showed no changes at the last follow-up. The degeneration grades of 292 discs (71.0%) were unchanged at the last follow-up, while 86 (20.9%) showed improvement, mostly at the upper adjacent segment. No significant difference was observed in the intervertebral height index or paraspinal muscle-disc ratio.

Conclusion: Both TELD and MD provide generally satisfactory long-term clinical outcomes for patients with LDH. TELD can be used as a reliable alternative to MD with less surgical trauma. Modic type II changes, decreased preoperative intervertebral height, and a high body mass index are predictors of a poor prognosis.

目的：比较经椎间孔内窥镜腰椎间盘切除术（TELD）与显微椎间盘切除术（MD）的长期临床和影像学疗效：回顾性分析了154名腰椎间盘突出症（LDH）患者的数据，这些患者接受了TELD（89人）或MD（65人）手术。采用腿部和腰部疼痛视觉模拟量表、日本骨科协会（JOA）评分和奥斯韦特里残疾指数（ODI）对患者的临床结果进行了评估。随访期间还观察了放射学表现的变化。研究还调查了临床效果不佳的潜在风险因素：在平均 5.5 年（5-7 年）的随访期间，TELD 组的复发率为 4.49%，MD 组为 1.54%。两组患者的所有评分从术前到术后均有明显改善（p 结论：TELD 和 MD 均可为 LDH 患者提供令人满意的长期临床疗效。TELD 可作为 MD 的可靠替代方案，手术创伤较小。莫迪II型改变、术前椎间高度降低和高体重指数是预后不良的预测因素。

{"title":"Comparison of Clinical and Radiographic Outcomes Between Transforaminal Endoscopic Lumbar Discectomy and Microdiscectomy: A Follow-up Exceeding 5 Years.","authors":"Xinyu Yang, Shijun Zhang, Junxiao Su, Sai Guo, Yakubu Ibrahim, Kai Zhang, Yonghao Tian, Lianlei Wang, Suomao Yuan, Xinyu Liu","doi":"10.14245/ns.2347026.513","DOIUrl":"10.14245/ns.2347026.513","url":null,"abstract":"Objective: To compare the long-term clinical and radiographic outcomes of transforaminal endoscopic lumbar discectomy (TELD) versus microdiscectomy (MD).Methods: The data of 154 patients with lumbar disc herniation (LDH) who underwent TELD (n = 89) or MD (n = 65) were retrospectively analyzed. The patients' clinical outcomes were evaluated using visual analogue scales for leg and low back pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI). The evolution of radiographic manifestations was observed during follow-up. Potential risk factors for a poor clinical outcome were investigated.Results: During a mean follow-up of 5.5 years (range, 5-7 years), the recurrence rate was 4.49% in the TELD group and 1.54% in the MD group. All scores significantly improved from preoperatively to postoperatively in both groups (p < 0.01). The improvement in the ODI and JOA scores was significantly greater in the TELD than MD group (p < 0.05). Forty-seven patients (52.8%) in the TELD group and 32 (49.2%) in the MD group had Modic changes before surgery, most of which showed no changes at the last follow-up. The degeneration grades of 292 discs (71.0%) were unchanged at the last follow-up, while 86 (20.9%) showed improvement, mostly at the upper adjacent segment. No significant difference was observed in the intervertebral height index or paraspinal muscle-disc ratio.Conclusion: Both TELD and MD provide generally satisfactory long-term clinical outcomes for patients with LDH. TELD can be used as a reliable alternative to MD with less surgical trauma. Modic type II changes, decreased preoperative intervertebral height, and a high body mass index are predictors of a poor prognosis.","PeriodicalId":19269,"journal":{"name":"Neurospine","volume":null,"pages":null},"PeriodicalIF":3.2,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10992631/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139692540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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