| Part One The treatment effect of posterior transforaminal lumbar interbody fusion surgery on patients suffering from lumbar disc herniation concurrent with peroneal nerve paralysisObjective: The purpose of this study is to investigate the clinical effect of posterior transforaminal lumbar interbody fusion surgery on patients who suffer from lumbar disc herniation concurrent with peroneal nerve paralysis.Methods: The patients suffering from peroneal nerve paralysis and undergoing posterior transforaminal lumbar interbody fusion surgery between January 2012 and December 2019 were retrospectively reviewed.The data of the identified patients were then collected and processed.All patients were followed up post-operatively after discharge from the hospital.The data was analyzed in terms of Oswestry disability index(ODI),visual analogue scale(VAS)score,and relative lower-limb muscle strength.Results: A total of 87 patients(52 males and 35 females)aged 54±11years met the inclusion criteria for this study.These patients stayed in hospital for 16±6 days and were followed up for 81±24 months.Data analysis showed that muscle strength of the tibialis anterior and extensor digitorum significantly recovered at the last follow-up with a grade of 3(median),compared to grade 0 at admission(P<0.001).Furthermore,the median VAS score decreased to 1 at the last follow-up from 6 at admission(P<0.001),and the ODI greatly improved with 10%(median)at the last follow-up,while it was 58% at admission(P<0.001).The ODI improvement rate was 60% on average at the last follow-up.Multivariate regression analysis regarding the ODI and muscle strength improvement rates showed that advanced age was a risk factor for postoperative recovery.Conclusions: Patients suffering from lumbar disc herniation concurrent with peroneal nerve paralysis can improve after undergoing posterior transforaminal lumbar interbody fusion surgery,but few can reach full recovery.Advanced age might be a risk factor that affects the prognosis of these patients after surgery.Part Two Percutaneous endoscopic transforaminal lumbar discectomy using no extra pressure technique in the treatment of lumbar disc herniation concurrent with cauda equina syndromeObjective: We introduced a new technique of percutaneous endoscopic transforaminal lumbar discectomy(PETD)for lumbar disc herniation(LDH)concurrent with cauda equina syndrome(CES)in the study and evaluate its clinical effect and complications compared to posterior transforaminal lumbar interbody fusion(TLIF)surgery.Methods: A retrospective study was made of 51 patients diagnosed as lumbar disc herniation concurrent with cauda equina syndrome between January 2016 and December 2020.According to different surgical methods,they were divided into two groups: 23 patients in the PETD group and 28 patients in the TLIF group.The technique of no extra pressure PETD in the treatment of cauda equina syndrome was introduced in detail.The surgical efficacy was evaluated by visual analog scale(VAS)of low back pain,VAS of lower limbs pain,Japanese Orthopaedic Association score(JOA),Oswestry Disability Index(ODI)and the cauda equina scale(TCS).Through follow-up,the VAS of low back pain,VAS of lower limbs pain,JOA,ODI,and TCS of the two groups at each time point before operation,before discharge and the last follow-up were compared to evaluate the clinical efficacy of PETD and the complications were also recorded.Results: All patients successfully completed the operation.At the last follow-up,VAS of low back pain,VAS of lower limbs pain,JOA,ODI and TCS in both groups were significantly improved(P<0.001);VAS and ODI of low back pain before discharge in PETD group were lower than those in TLIF group,and the difference was statistically significant(P=0.011,P=0.027);There was no significant difference in other therapeutic indexes at each follow-up.There were 2 cases of neck pain and 1 case of recurrence of intervertebral disc herniation in PETD group.There was 1 case of adjacent segment degeneration at the last follow-up in TLIF group.Conclusions: PETD using no extra pressure technique for the treatment of LDH concurrent with CES has equal clinical effect to TLIF;PETD using no extra pressure technique has faster improvement of symptoms after surgery.Part Three Percutaneous endoscopic lumbar decompression surgery for elderly degenerative lumbar spinal stenosisObjective: The purpose of this study is to investigate the clinical efficacy and safety of percutaneous endoscopic lumbar decompression for elderly patients with degenerative lumbar spinal stenosis.Methods: According to the inclusion and exclusion criteria,87 elderly patients with degenerative lumbar spinal stenosis were recruited,which were divided into two groups according to the types of operation,group PELD 47 patients and group PTLIF 40 patients.The general data of the two groups were summarized: age,gender,ASA,operating segment,preoperative visual analysis scale,preoperative VAS of low back,VAS of lower extremities and Oswestry disability index.VAS of low back pain,VAS of lower extremities and ODI were also analyzed at 6 weeks,6 months and the last follow-up.Then the operation time,hospitalization time,perioperative and late complications of the two groups were compared.Results: The preoperative data of the two groups: the average age of patients in the PELD group was 75.6 years old,and that in the PTLIF group was 73.2 years old,the difference was statistically significant(P=0.024).The preoperative VAS score of PELD group was 3.3±1.3,and the preoperative VAS score of low back pain of PTLF group was 4.1±1.4,the difference was statistically significant(P<0.05).The other preoperative data,such as gender,ASA classification,operative segment,preoperative VAS of lower extremities,preoperative ODI,had no statistical difference(P>0.05).Operation condition: the operation time and hospitalization time of PELD group were significantly shorter than PTLIF group(P<0.001);there was no significant difference in perioperative and late complications between the two groups(P>0.05),but the the types of complications are different.Conclusions: The clinical effect of PELD in the treatment of degenerative lumbar spinal stenosis in the elderly is equal to that of PTLIF;Older patients with milder back pain are more suitable. |
