Objective To determine the contents of matrix metalloproteinase 3 (MMP-3) and interleukin 1 (IL-1) in the tissues of the lumbar disc herniation and to investigate their roles in the pathogenesis. Methods The tissues of the herniated lumbar disc were obtained from 30 patients undergoing surgery for persistent radiculopathy from June 2003 to December 2004 and at the same time these samples were divided into the following three experimentalgroups: the bulge group (n=11), the protrusion group (n=9), and the prolapsus group (n=10)，14 males, 16 females, aged 33.64 years. As the control group, 9 lumbar disc specimens were harvested from 9 patients(4 males, 5 females, aged 21-58 years) suffering from bursting fracture of the lumbar spine. The specimens were analyzed by the ELISA method for the contents of MMP-3 and IL-1. Results The contents of MMP-3(14.25±1.32, 19.89±2.97,20.69±2.18 ng/ml in the bulge group, protrusion group and prolapsus group, separately) and IL-1(8.52±0.22， 11.88±0.52，11.90±0.73 pg/ml in the bulge group, protrusion group and prolapsus group, separately) in the experimental groups were significantly higher than those in the control group. The contents of MMP-3 and IL-1 in the protrusion group were not significantly higher than those in the prolapsus group, but they were significantly higher than those in the bulge group(P＜0.01). The contents of MMP-3 had a significant relationship with the contents of IL-1 in the three experimental groups and the control group(P＜0.01). Conclusion The result demonstrates that the tissues of the lumbar disc herniation can produce both MMP-3 and IL-1, which may have an unknown but important relationship with each other.
ObjectiveTo explore the feasibility and effectiveness of unilateral pedicle screw rod and single poly (ether-ether-ketone) (PEEK) Cage for lumbar intervertebral disc protrusion. MethodsA total of 126 cases of single segment of lumbar intervertebral disc protrusion between January 2006 and June 2012 were divided into 2 groups in the randomized clinical trial. Unilateral pedicle screw fixation and single PEEK Cage was used in 63 cases (research group), and bilateral pedicle screw fixation and single PEEK Cage in 63 cases (control group). There was no significant difference in gender, age, disease duration, side, and affected segment between 2 groups (P>0.05). Schulte evaluation criterion was used to assess bone graft fusion, Oswestry disability index (ODI) to estimate the quality of life situation, and visual analogue scale (VAS) to evaluate the improvements of lower back pain. Macnab standards was applied to assess postoperative effectiveness, and Emery ways to measure the height of intervertebral space. ResultsThe incision length, operation time, intraoperative blood loss, hospitalization time, and hospitalization fee in research group were significantly less than those in control group (P<0.05). The patients were followed up 12-79 months (mean, 21.3 months) in research group, and 15-73 months (mean, 22.6 months) in control group. The postoperative lordosis was recovered well, and the height of intervertebral space was increased. No loosening or breakage of internal fixation occurred. The time of bone graft fusion was (6.8±1.3) months in research group and was (7.1±1.2) months in control group, showing no significant difference (t=1.153, P=0.110). The height of intervertebral space, ODI score, and VAS score were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but no significant difference was found between 2 groups at preoperation and last follow-up (P>0.05). At 3 months after operation, postoperative effectiveness was assessed according to Macnab criterion, the excellent and good rate was 95.23% in research group (excellent in 13 cases, good in 47 cases, and fair in 3 cases) and was 71.42% in control group (excellent in 7 cases, good in 38 cases, fair in 15 cases, and poor in 3 cases); the research group was significantly superior to control group (χ2=6.110, P=0.006). ConclusionUnilateral pedicle screw fixation and single PEEK Cage has the advantages of small trauma, reliable fixation, shorter operation time, less bleeding, less economic cost, and early off-bed activity time. It can provide a simple and reliable choice in single segmental lumbar intervertebral disc protrusion.
ObjectiveTo investigate the effect of body mass index (BMI) on the outcome of posterior 360° fusion for single-level lumbar degenerative diseases. MethodsA retrospective study was carried on 302 cases of singlelevel lumbar degenerative diseases treated with posterior 360° fusion between September 2009 and September 2013. All patients were divided into 3 groups according to BMI: normal weight (BMI<24 kg/m2) in 105 cases (group A), overweight (24 kg/m2≤BMI< 28 kg/m2) in 108 cases (group B), and obese (BMI≥28 kg/m2) in 89 cases (group C). There was no significant difference in gender, age, disease duration, disease patterns, affected segments, preoperative Japanese Orthopaedic Association (JOA) score and Oswestry disability index (ODI) among 3 groups (P>0.05). The operation time, intraoperative blood loss, postoperative hospital stay, and complications were recorded. The lumbar function was assessed by JOA score and ODI at pre- and post-operation (at 3, 6, and 24 months). ResultsThe operation time, intraoperative blood loss, and postoperative hospital stay of group C were significantly more than those of groups A and B (P<0.05), but no significant difference was found between group A and group B (P>0.05). The patients were followed up 24-45 months. Postoperative JOA score and ODI showed significant improvements in each group when compared with preoperative ones (P<0.05), but there was no significant difference among groups at each time point after operation (P>0.05). There was no significant difference in the incidence of total complications among 3 groups (χ2=3.288, P=0.193). The incidence of incision-related complications (infection and poor healing) in group C was significantly higher than that of groups A and B (P<0.05), but no significant difference was shown between group A and group B (P>0.05). However, there was no significant difference in cerebrospinal fluid leak, pseudarthrosis formation, and revision among 3 groups (P>0.05). ConclusionPosterior 360° fusion for single-level lumbar degenerative diseases can obtain good effectiveness in patients with different BMI, but patients whose BMI was ≥28 kg/m2 have longer operation time, more intraoperative blood loss, longer hospital stay, and higher incidence of postoperative incision-related complications.
ObjectiveTo investigate the effectiveness and safety of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for upper lumbar disc herniation. MethodsRetrospective analysis was made on the clinical data of 26 patients with upper lumbar disc herniation, who were in line with the selection criteria and underwent MIS-TLIF in 14 patients (MIS-TLIF group) and open transforaminal lumbar interbody fusion (OTLIF) in 12 patients (OTLIF group) between December 2007 and May 2012. There was no significant difference in gender, age, disease duration, level of disc herniation, side of disc herniation between 2 groups (P>0.05). The operation time, intraoperative blood loss, postoperative drainage volume, and complications were compared between 2 groups. The clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI) scores. The fusion rate was determined by using CT three-dimensional reconstruction and dynamic lumbar radiography at last follow-up. ResultsPrimary healing of incisions was obtained in both groups. No difference was found in operation time between 2 groups (t=0.858, P=0.399), but MIS-TLIF group had less intraoperative blood loss and postoperative drainage volume than OTLIF group (P<0.05). The average follow-up duration was 34.1 months with a range of 12-50 months. No complication of dural tear, infection, spinal nerve trauma, and implant failure occurred. The VAS scores of lower back pain and radicular pain and ODI scores at preoperation showed no significant difference between 2 groups (P>0.05). The VAS score of lower back pain and ODI score at 1 day after operation in MIS-TLIF group were significantly lower than those in the OTLIF group (P<0.05), but no difference was found in VAS scores of radicular pain between 2 groups (P>0.05). Difference in all scores was not significant at last follow-up between 2 groups (P>0.05). The fusion rate was 92.8% (13/14) in MIS-TLIF group, and was 100% (12/12) in OTLIF group at last follow-up. ConclusionMIS-TLIF is a safe and effective procedure for upper lumbar disc herniation as an alternative to other techniques.
Lumbar disc herniation is one of the most common causes of low back and leg pain in clinic. There are a lot of non-surgical therapeutic methods widely used in clinic for treating lumbar disc herniation. The author assessed the available systematic reviews of non-surgical methods in treating lumbar disc herniation which had been published in these years, and finally a total of 13 systematic reviews were retrieved including 1 about conservative treatments, 8 Chinese medicine treatments, and 4 percutaneous treatments, such as chemonucleolysis and epidural steroid injection. The results showed that the conservative treatments included injections, traction, physical therapy, bed rest, manipulation, medication, and acupuncture. But no evidence was found to show that any of the above treatments was clearly superior to others including no treatment for patients with lumbar disc herniation. The outcomes from some reviews showed that Chinese medicine treatments were safer and comprehensive treatment of traditional Chinese medicine was relatively effective compared with single treatment. Electro-acupuncture, compared with conventional therapy (bed rest, waist protection, pelvic traction, manual or physical therapy) and oral medications as well, was safe and effective in alleviating pain and improving overall function. Chinese medicinal fumigation combined with traction was more effective than single treatment. Percutaneous treatment of chemonucleolysis had much better short-term effectiveness. Percutaneous epidural steroid injection also had certain effects. To summarize, Chinese medicine and percutaneous treatments may be effective in treating lumbar disc herniation. However, more clinical trials are needed, since current evidence is of low quality.
Objective To evaluate the effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) combined with Coflex interspinous process dynamic reconstruction system for the treatment of youth lumbar disc herniation (LDH). Methods The clinical data of 52 patients with LDH treated by PTED combined with Coflex were retrospectively analyzed between February 2013 and March 2015. The involved segments were L4, 5 in 30 cases and L5, S1 in 22 cases. In 30 patients at L4, 5 level, there were 18 males and 12 females with an average age of 25 years (range, 18-34 years) and a mean disease duration of 10 months (range, 6-16 months). In 22 patients at L5, S1 level, there were 10 males and 12 females with an average age of 25.5 years (range, 19-32 years) and a mean disease duration of 12 months (range, 6-18 months). The operation time and intraoperative blood loss were recorded. Oswestry disability index (ODI) and Japanese Orthpoaedic Association (JOA) score were used for effectiveness assessment. Radiograpic indexes were calculated on X-ray films before operation and final follow-up, including ventral intervertebral space height (VH), dorsal intervertebral space height (DH), intervertebral foramen height (IFH), the range of motion (ROM) of involved segment, and the ROM of upper adjacent segment. Results The operations were successfully completed in 52 patients. The operation time and intraoperative blood loss were (89.7±16.5) minutes and (42.7±11.3) mL in patients at L4, 5 level, and were (94.6±18.2) minutes and (47.6±13.4) mL in patients at L5, S1 level. Incisions healed by first intention. All patients were followed up 12-18 months (mean,16 months) in patients at L4, 5 level and 12-20 months (mean, 17 months) in patients at L5, S1 level. At final follow-up, ODI, and JOA score were significantly improved when compared with preoperative ones in all patients (P<0.05). X-ray films showed no complication of Coflex loosening, spinous process fracture, or articular process fracture occurred. At final follow-up, VH, DH, and IFH were significantly improved when compared with preoperative ones in all patients (P<0.05), and the ROM of involved segment was significantly reduced compared with preoperative one (P<0.05), but the ROM of upper adjacent segment showed no significant difference when compared with preoperative one (P>0.05). Conclusion PTED combined with Coflex is a safe and effective minimally invasive surgery in treating youth LDH; however, it still needs further clinical studies.
ObjectiveTo evaluate the short-term effectiveness of percutaneous endoscopic lumbar discectomy (PELD) in treatment of buttock pain associated with lumbar disc herniation.MethodsBetween June 2015 and May 2016, 36 patients with buttock pain associated with lumbar disc herniation were treated with PELD. Of 36 cases, 26 were male and 10 were female, aged from 18 to 76 years (mean, 35.6 years). The disease duration ranged from 3 months to 10 years (mean, 14 months). The location of the pain was buttock in 2 cases, buttock and thigh in 6 cases, buttock and the ipsilateral lower extremity in 28 cases. Thirty-four patients had single-level lumbar disc herniation, and the involved segments were L4, 5 in 15 cases and L5, S1 in 19 cases; 2 cases had lumbar disc herniation at both L4, 5 and L5, S1. The preoperative visual analogue scale (VAS) score of buttock pain was 6.1±1.3. VAS score was used to evaluate the degree of buttock pain at 1 month, 3 months, 6 months, and last follow-up postoperatively. The clinical outcome was assessed by the modified MacNab criteria at last follow-up.ResultsAll patients were successfully operated and the operation time was 27-91 minutes (mean, 51 minutes). There was no nerve root injury, dural tear, hematoma formation, or other serious complications. The hospitalization time was 3-8 days (mean, 5.3 days). All incisions healed well and no infection occurred. Patients were followed up 12-24 months (median, 16 months). MRI examination results showed that the dural sac and nerve root compression were sufficiently relieved at 3 months after operation. Patients obtained pain relief after operation. The postoperative VAS scores of buttock pain at 1 month, 3 months, 6 months, and last follow-up were 1.1±0.6, 0.9±0.3, 1.0±0.3, and 0.9±0.4 respectively, showing significant differences when compared with preoperative VAS scores (P<0.05); there was no significant difference in VAS score between the different time points after operation (P>0.05). At last follow-up, according to the modifed MacNab criteria, the results were excellent in 27 cases, good in 9 cases, and fair in 2 cases, and the excellent and good rate was 94.4%.ConclusionPELD can achieve satisfactory short-term results in the treatment of buttock pain associated with lumbar disc herniation and it is a safe and effective minimally invasive surgical technique.
ObjectiveTo investigate the feasibil ity and short-term effectiveness of percutaneous endoscopic spine surgery for treatment of lumbar disc herniation with posterior ring apophysis separation. MethodsBetween July 2008 and January 2013, 57 patients with lumbar disc herniation and posterior ring apophysis separation were treated. There were 39 males and 18 females, aged from 13 to 46 years (mean, 26.7 years). Of 57 cases, 29 had a clear trauma history. All patients had single segmental unilateral lumbar disc herniation, and the location was at L4, 5 in 22 cases and at L5, S1 in 35 cases; there were 25 cases of lateral bone fragments and 32 cases of central cortical and cancellous fragments. While fracture located at posterior inferior edge of the vertebrae at L4 level in 9 cases and at L5 level in 8 cases, at posterior superior edge at L5 level in 13 cases and in S1 level in 27 cases. Percutaneous endoscopic surgeries were performed via interlaminar or transforaminal approach from unilaterally symptomatic side for discectomy of lumbar disc herniation and partial or complete resection of free bone fragments. ResultsAccurate positioning was obtained in all patients during operation, and no complication of nerve root injury, hematoma formation, or dural tear occurred. The operation time was 20-85 minutes; the intraoperative fluoroscopy times were 2-15 times, and the blood loss was 3-10 mL. Postoperative radiographic examination showed that bone fragment was not removed in 16 cases, was partly removed in 32 cases, and was completely removed in 9 cases. Disc was completely removed. All patients were followed up 10-64 months (median, 16 months). According to modified Macnab criteria for the evaluation of effectiveness, the results were excellent in 48 cases, good in 6 cases, and fair in 3 cases, and the excellent and good rate was 94.7%. ConclusionPercutaneous endoscopic spine surgery through unilaterally symptomatic approach has advantages of small tissue damage and lumbar structure damage, less bleeding, and shorter recovery time. It has a good short-term effectiveness, but long-term effectiveness need further follow-up.
目的:观察胶原酶治疗腰椎间盘突出的疗效。方法:对1218例不同程度的腰椎间盘突出患者进行椎旁穿刺,注入胶原酶1200u进行溶解治疗。结果:91%的患者取得较好疗效,9%的患者疗效欠佳。结论:胶原酶是治疗腰椎间盘突出的一种有效方法。