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Background: Hidden blood loss (HBL) is a notable complication in spinal endoscopic procedures. This study aims to compare tissue damage and hidden blood loss between two minimally invasive spinal techniques: unilateral biportal endoscopic lumbar discectomy (UBE) and percutaneous endoscopic interlaminar discectomy (PEID). Furthermore, the study examines the risk factors contributing to hidden blood loss in each procedure., Patients and Methods: A single-center retrospective cohort study was conducted on 86 patients who underwent unilateral biportal endoscopic lumbar discectomy (UBE) and 73 patients who received percutaneous endoscopic interlaminar discectomy (PEID) between January 2021 and December 2023.Demographic data, blood loss parameters, and serum levels of creatine kinase (CK) and C-reactive protein (CRP) were recorded. Pearson or Spearman correlation analyses were conducted to evaluate associations between patient characteristics and HBL. Additionally, multiple linear regression analysis was used to identify independent risk factors for HBL., Results: A total of 159 consecutive patients were included in this study, consisting of 83 females and 76 males. The average hidden blood loss (HBL) was 431.00 ± 160.52 ml in the UBE group and 328.40 ± 87.71 ml in the PEID group, showing a statistically significant difference (P < 0.05). Pearson or Spearman correlation analysis indicated that in the UBE group, HBL was associated with operation time, preoperative hematocrit (Hct), ASA classification, and paraspinal muscle thickness. In the PEID group, HBL was correlated with operation time, preoperative activated partial thromboplastin time (APTT), paraspinal muscle thickness, and the presence of diabetes (P < 0.05). Multiple linear regression analysis demonstrated a positive correlation between HBL and operation time in both groups (P < 0.05), identifying operation time as an independent risk factor for HBL. Furthermore, CRP and CK levels were generally lower in the PEID group compared to the UBE group, particularly on postoperative day 3 for CRP and postoperative day 1 for CK. Both total blood loss and hidden blood loss were significantly lower in the PEID group than in the UBE group., Conclusion: Compared to UBE, PEID shows superior results regarding surgical trauma, total blood loss, hidden blood loss (HBL), and postoperative hematocrit (Hct) reduction. Consequently, PEID is recommended as the treatment of choice for younger patients or those with compromised baseline perioperative conditions.Additionally, Hidden blood loss remains a critical factor, and surgical duration presents a shared risk in both procedures., Competing Interests: Declarations. Ethical approval: This project is supported by the 2023 Central Government-Led Local Science and Technology Development Fund, under the project “Standardization and Promotion of Single and Double-Channel Spinal Endoscopic Techniques” (Project No. 2023ZY013). This project does not involve the collection, preservation, utilization, external provision, or management of human genetic resources. Therefore, it has been exempted from ethical review by the Ethics Committee of Qinghai Red Cross Hospital. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Background: Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated variable efficacy in alleviating low back pain (LBP) associated with lumbar disc herniation (LDH). Sinuvertebral nerve ablation (SNA), which targets the nociceptive pathway implicated in discogenic LBP pathogenesis, has emerged as a potential adjunctive therapy. The efficacy of endoscopic radiofrequency ablation in enhancing PELD for the treatment of LBP in patients with LDH remains unclear., Methods: A retrospective cohort study was conducted on LDH patients with concomitant LBP treated at the Spinal Surgery Department, China-Japan Friendship Hospital, from June 2020 to June 2023. Participants were categorized into two groups: PELD combined with SNA (n = 51) and PELD alone (n = 46). Primary outcome measures included the Visual Analog Scale (VAS) for pain, the Japanese Orthopaedic Association (JOA) score, and the Oswestry Disability Index (ODI) at baseline and 1-, 3-, and 6-month follow-ups., Results: Both groups exhibited significant improvements in VAS, JOA, and ODI scores for LBP and leg pain postoperatively compared to preoperative assessments. Notably, the PELD combined with SNA group demonstrated statistically significant superior outcomes in VAS, JOA, and ODI scores specifically for LBP compared to the PELD group., Conclusion: The combination of PELD with SNA significantly improves LBP outcomes compared to PELD alone in LDH patients. While the observed improvements did not reach the minimal clinically important differences (MICD), these findings suggest that SNA may enhance the efficacy of PELD in LBP management., Competing Interests: Declarations Ethical approval The study declares that all protocols were conducted in accordance with the ethical standards set forth in the Declaration of Helsinki and received approval from the Clinical Research Ethics Committee of the China-Japan Friendship Hospital (2022-KY-104). We declare that written informed consent was obtained from all participating patients. Competing interests Yanjun Huang, Shangshu Wei, Shuyue Yang, Yanzhu Shen, Ping Yi and Xiangsheng Tang state that they don’t have any conflicting interests., (© 2024. The Author(s).)

Objective: This study aimed to compare the efficacy and cost-utility of unilateral biportal endoscopy (UBE) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of single-level lumbar disc herniation (LDH)., Methods: A retrospective analysis was conducted on 99 patients who underwent either UBE (n = 33) or PEID (n = 66) between July 2022 and December 2023 at the Second Xiangya Hospital. Patients were matched 1:2 based on age, sex, and surgery level to ensure comparability. Clinical outcomes were assessed using Visual Analog Scale (VAS), European Quality of Life-5 Dimensions (EQ-5D), and Oswestry Disability Index (ODI) scores, with quality-adjusted life years (QALYs) calculated for cost-utility analysis. Hospitalization costs were analyzed, and the incremental cost-utility ratio (ICER) was determined., Results: Both UBE and PEID groups demonstrated significant postoperative improvements in VAS, EQ-5D, and ODI scores (p < 0.05). The operative time, blood loss and nursing cost were significantly higher for UBE compared to PEID (p < 0.05). UBE has higher gained QALY and overall costs, but the differences are not statistically significant (p = 0.643 for QALY, p = 0.327 for costs). The Incremental Cost-Effectiveness Ratio (ICER) for UBE compared to PEID was calculated to be $354.5 per QALY gained, indicating that for each additional QALY gained through UBE, an additional cost of $354.5 is incurred compared to PEID., Conclusion: In our single-center study conducted in China, both the UBE and PEID procedures have demonstrated comparable short-term efficacy in alleviating pain and improving functional ability in patients with single-level LDH. UBE procedure demonstrates greater cost-utility than the PEID procedure in cost-utility analysis, despite its longer operative time, higher nursing costs and greater blood loss., Competing Interests: Declarations Ethical approval The study protocol was conducted retrospectively from data obtained for clinical purposes, which was approved by the Institutional Review Board of Second Xiangya Hospital of Central South University, Hunan, China. Consent for publication Not applicable. Informed consent Written informed consent was obtained from each patient for publication of this study. Statement of human and animal rights There are no experimental procedures involving animals or humans and statement of human or animal rights is not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: We compared the long-term outcomes of percutaneous endoscopic lumbar discectomy (PELD) with those of open fenestration discectomy (OFD) in treating lumbar disc herniation (LDH)., Methods: 281 patients were included from January 2013 to December 2018, of whom 228 underwent PELD and 53 underwent OFD. General information of patients was collected and imbalances in covariates between groups were corrected using propensity score matching (PSM). Then, the clinical function scores, imaging data, and complications were compared., Results: Among participants, 102 patients were successfully matched and were followed for 62-128 months. Compared to the OFD group, the PELD group indicated greater improvements in visual analog scale score of low back pain (VAS-BP), Japanese orthopedic association (JOA), and Oswestry disability index (ODI) at 7 days postoperatively and the last follow-up (P < 0.05). At 24 months postoperatively and the last follow-up, the disc height index (DHI), ratio of grays (RVG), and range of motion (ROM) were higher and the compass value was lower (P < 0.05) in the PELD group compared to the OFD group, suggesting that the PELD procedure better maintained the mobility and stability of the responsible segment after surgery. The recurrence rates between the PELD (9.80%) and OFD (7.84%) groups did not reveal statistical differences (P > 0.05)., Conclusion: PELD and OFD both provide acceptable clinical outcomes for LDH. However, PELD is superior to OFD in terms of relieving low back pain, delaying disc degeneration, and maintaining segmental stability., Competing Interests: Declarations Ethics approval and consent to participate Ethics committee approval by the Committee of the Sixth Medical Center of the PLA General Hospital (HZKY-PJ-2024-35). Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Background: Residual low back and leg pain can occur after percutaneous endoscopic interlaminar discectomy (PEID) and compromise early surgical outcomes. This study aimed to determine the efficacy of combining dexamethasone with vitamin B12 (VB12) via epidural injection in improving the symptoms of low back and leg pain after PEID, and the underlying mechanism of action., Methods: Patients who underwent PEID for lumbar disc herniation (LDH) were enrolled and randomly assigned to the single surgery (SS) group, where disc removal was performed via PEID alone, or the combined treatment (CT) group, which received epidural injections of dexamethasone and VB12 alongside surgery. The outcome measures were the Visual Analog Scale (VAS), Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI), serum inflammatory factor expression, adverse surgical events, duration of postoperative hospitalization, and modified MacNab criteria., Results: Compared with the SS group, the CT group exhibited lower VAS scores for low back and leg pain at 1, 3, and 7 days post-surgery (P < 0.05). JOA and ODI scores were significantly improved in the CT group than in the SS group 7 days post-surgery (P < 0.05); however, no significant differences were observed at other time points. Serum inflammatory factors were lower in the CT group than in the SS group 3 days post-surgery (P < 0.05). The duration of postoperative hospitalization was shorter in the CT group (P < 0.05). Both groups had similar good outcomes (89.3% vs. 92.2%, P = 0.945)., Conclusions: Epidural injection of dexamethasone and VB12 effectively reduces early postoperative low back and leg pain, lowers postoperative inflammatory factor expression, and improves early PEID outcomes. Its clinical adoption merits consideration., Trial Registration: This trial was registered with the China Clinical Trial Registration Center (Identifier: ChiCTR2400088854)., (© 2024. The Author(s).)

Purpose: Introducing a suture repair technology, endoscopic double line suture repair technique, for iatrogenic dural injury during Percutaneous Endoscopic Lumbar Discectomy (PELD) surgery., Methods: A patient with dural injury and cauda equina herniation during PELD surgery was treated with endoscopic double line suture repair technique., Results: A patient with dural injury and cauda equina nerve herniation during PELD surgery was successfully treated using double-line suture technique. After the repair, no obvious cerebrospinal fluid leakage and cauda equina nerve re-herniation was seen. During the postoperative observation period, the wound healed well and there were no complications related to cerebrospinal leakage. During the follow-up period (1 year), the patient reported significant symptom relief and no complications., Conclusion: This novel dural repair technology is safe and effective and can be used to treat dural injuries during PELD surgery., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The objective of this study was to analyze the effects of annulus fibrosus incision and foraminoplasty on lumbar biomechanics during posterior lateral approach translaminar percutaneous endoscopic lumbar discectomy (PELD) using a lumbar 4/5 segment model and three-dimensional finite element analysis (FEA). We created a model of the L4 to L5 segment and performed simulated foraminoplasty, annulus fibrosus incision, and a combined operation. The models were tested under six working conditions, and we recorded the deformation and equivalent strain/stress of each group. Results showed that foraminoplasty can affect the stability and rotation axis of the segment during rotation without significantly impacting discal stress. Conversely, annulus fibrosus incision significantly increases discal stress except for when the patient is doing a forward flexion movement. We recommend that surgical maneuvers minimize the removal and destruction of the annulus fibrosus and that rotation movements are avoided during the short-term recovery period following PELD surgery.

This retrospective study aimed to investigate the clinical efficacy of single-channel percutaneous endoscopic nucleotomy combined with annulus fibrosus suturing for treating lumbar disc herniation (LDH). The study included 86 patients with LDH treated in our spinal department from August 2020 to January 2022. The suture group consisted of 26 males and 18 females, while the control group (nucleotomy alone) included 25 males and 17 females. All patients were followed for at least 1 year, with follow-up points at 3 days, 3 months, and 12 months postoperatively. Various clinical and radiological indicators were used to evaluate and compare the efficacy and safety of the 2 procedures. No statistically significant differences were observed in age, sex, BMI, surgical segments, degree of disc degeneration, or postoperative length of hospital stay. However, the suture group had a longer operative time (63.28 ± 4.17 minutes vs 54.71 ± 4.89 minutes, t = 8.759, P < .05). At 12 months postoperatively, neither group showed aggravated disc degeneration. There was also no significant difference in excellent rates between the 2 groups (95.45% vs 92.86%, X2=0.265, P = .607). However, the suture group had a lower intervertebral disc height loss rate compared to the control group (22.3% ± 4.6% vs 29.8% ± 6.2%, X2=6.390, P < .001). In conclusion, single-channel percutaneous endoscopic nucleotomy combined with annulus fibrosus suturing is a safe and reliable treatment for LDH. It effectively reduces the recurrence rate, slows disc degeneration and loss of disc height, and achieves excellent early outcomes., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: This study investigates the clinical efficacy and safety of percutaneous endoscopic nucleotomy combined with platelet-rich plasma (PRP) injection in treating lumbar disc herniation (LDH) in young and middle-aged adults., Methods: From April 2022 to September 2023, 60 patients diagnosed with LDH were randomly divided into two groups (n = 30/group). The observation group underwent percutaneous endoscopic nucleotomy combined with autologous PRP gel injection into the disc, while the control group underwent percutaneous endoscopic nucleotomy alone. Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI) scores were recorded preoperatively and at three time points postoperatively: three days, three months, and six months. The modified Macnab criteria were employed to evaluate efficacy at the final follow-up. Additionally, MRI Pfirrmann grading of the operated disc segment and potential complications were assessed both preoperatively and at the final follow-up., Results: All patients were followed for a minimum of six months. VAS and ODI scores at all postoperative time points (three days, three months, and six months) exhibited significant differences compared to preoperative scores in both groups (P < 0.05). Notably, a significant difference was observed in VAS and ODI scores between the two groups at three days postoperatively (P < 0.05). Preoperative MRI Pfirrmann grading indicated no significant difference between groups (P = 0.669). However, at the final follow-up, the observation group demonstrated superior recovery compared to the control group (P = 0.013). The modified Macnab criteria revealed no significant difference in the rates of excellent and good outcomes between the observation group (96.67%) and the control group (93.33%) (P > 0.05). Furthermore, no patients experienced complications such as dural tears, nerve root injury, infection, or hematoma., Conclusion: The combination of percutaneous endoscopic nucleotomy and PRP injection could be a safe and effective treatment for LDH in young and middle-aged adults to promote disc repair following endoscopic procedures., (© 2024. The Author(s).)

To compare the clinical efficacy of lumbar percutaneous transforaminal endoscopic discectomy (PTED) for lumbar disc herniation (LDH) guided by C-arm fluoroscopy and ultrasound volumetric navigation (UVN). Fifty patients with LDH treated with PTED were retrospectively evaluated in this study. Groups A (n = 25) and B (n = 25) had intervertebral foramina punctures guided by C-arm fluoroscopy and UVN, respectively. The age, gender, height, weight, and body mass index of patients were recorded. We compared the puncture time, number of punctures, and puncture accuracy of patients in both groups. We also evaluated the clinical effectiveness of PTED surgery using the visual analog scale (VAS) and the Oswestry Disability Index (ODI). In addition, we recorded the duration of surgery, hospitalization, medical costs, and surgical complications in both groups. The average follow-up time of the 50 patients was 18.5 ± 4.3 months. The mean puncture time in groups A and B was 25.76 ± 5.28 and 14.34 ± 4.96 minutes, respectively, and the difference was statistically significant (P < .05). The mean number of fluoroscopies was significantly lower in group B than in group A, with 15.82 ± 2.29 versus 4.52 ± 0.51 times (P < .05). The puncture accuracy rate was 100% in both groups, with no statistical difference (P > .05). The VAS and ODI scores of patients in group A were similar to group B at all 3-time points: preoperatively, at 3 months postoperatively, and at 1 year postoperatively. However, both VAS and ODI were significantly improved postoperatively compared to preoperatively (P < .05). Moreover, group B has shorter operative time and higher medical cost than group A (P < .05). There was no significant difference in the length of hospitalization and surgical complication rate (P > .05). Both C-arm-guided and the UVN-guided PTED are safe and effective methods for the treatment of LDH. UVN-guided technique has the advantage of reducing puncture time and the number of punctures. However, UVN also has the disadvantage of high hospitalization costs., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: In recent years, radiomics has been shown to be an effective tool for the diagnosis and prediction of diseases. Existing evidence suggests that imaging features play a key role in predicting the recurrence of lumbar disk herniation (rLDH). Thus, this study aimed to evaluate the risk of rLDH in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) using radiomics to facilitate the development of more rational surgical and perioperative management strategies., Method: This was a retrospective case-control study involving 487 patients who underwent PELD at the L4/5 level. The rLDH and negative groups were matched using propensity score matching (PSM). A total of 1409 radiomic features were extracted from preoperative lumbar MRI images using intraclass correlation coefficient (ICC) analysis, t-test, and LASSO analysis. Afterward, 6 predictive models were constructed and evaluated using ROC curve analysis, AUC, specificity, sensitivity, confusion matrix, and 2 repeated 3-fold cross-validations. Lastly, the Shapley Additive Explanation (SHAP) analysis provided visual explanations for the models., Results: Following screening and matching, 128 patients were included in both the recurrence and control groups. Moreover, 18 of the extracted radiomic features were selected for generating six models, which achieved an AUC of 0.551-0.859 for predicting rLDH. Among these models, SVM, RF, and XG Boost exhibited superior performances. Finally, cross-validation revealed that their accuracy was 0.674-0.791, 0.647-0.729, and 0.674-0.718., Conclusion: Radiomics based on MRI can be used to predict the risk of rLDH, offering more comprehensive guidance for perioperative treatment by extracting imaging information that cannot be visualized with the naked eye. Meanwhile, the accuracy and generalizability of the model can be improved in the future by incorporating more data and conducting multicenter studies., (© 2024. The Author(s).)

Background: Interlaminar endoscopic lumbar discectomy (IELD) is a prevalent method for managing lumbar disc herniation. Local anesthesia (LA) is frequently employed during IELD, albeit with its merits and drawbacks. The spinal anesthesia (SA) represents a feasible anesthetic strategy for IELD; however, the availability of clinical research data is currently limited., Methods: The propensity score matching was conducted to ensure the comparability of the SA and LA groups. The outcome measures were operation time, intraoperative visual analogue scale (VAS) for pain, need for adjuvant analgesia, intraoperative vital signs, blood loss, adverse surgical events, anesthesia-related complications, postoperative bed rest duration, VAS for pain at 2 h postoperatively, Oswestry Disability Index score (ODI), satisfaction with surgical efficacy, and willingness to undergo reoperation at 6 months postoperatively., Results: Fifty-six patients were assigned to each group. Significant differences were found between the groups regarding intraoperative VAS for pain, use of adjuvant analgesics, willingness to undergo reoperation, maximum intraoperative systolic blood pressure, and variability (P < 0.05). Compared to the LA group, the SA group had lower VAS for pain at 2 h postoperatively, a longer operation time, a longer duration of postoperative bedrest, and more anesthesia-related complications (P < 0.05). No significant intergroup differences were detected in intraoperative heart rate variability, blood loss, ODI, satisfaction with surgical efficacy, and surgery-related complications (P > 0.05)., Conclusion: SA as an alternative anesthesia for IELD surgery holds great promise, exhibiting superior efficacy compared to LA. However, it is crucial to meticulously evaluate the indications due to potential risks associated with this form of anesthesia., (© 2024. The Author(s).)

Percutaneous endoscopic lumbar discectomy (PELD) is increasingly used in patients with lumbar disc herniation due to its less invasive nature and faster recovery. In this study, we aimed to investigate the prognostic factors associated with patient satisfaction index (PSI) in PELD. A retrospective study of 337 patients who underwent PELD between November 2015 and October 2020 in our department was conducted. Preoperative data of the enrolled patients were recorded. A logistic regression model was developed to explore the preoperative factors associated with postoperative PSI. After a mean follow-up of 28.7 ± 3.6 months, 310 patients were satisfied (NASS score of 1 or 2) and 27 patients were dissatisfied (NASS score of 3 or 4), resulting in a patient satisfaction rate of 91.99%. Demographic data, clinical symptom characteristics, and neurological physical examinations (including lower limb hypesthesia, muscle strength, and tendon flex) did not show any significant differences between the four groups (NASS1,2,3,4). The satisfactory group showed a higher rate of positive Lasegue sign (P = 0.010) and higher preoperative VAS (P = 0.002). The dissatisfaction group showed a higher rate of contiguous double-level disc herniation (P = 0.003). Our findings indicated that positive Lasegue sign and high preoperative VAS were prognostic factors for patient-reported satisfaction and PELD might not be the first choice for contiguous double-level disc herniation., (© 2024. The Author(s).)

This study compared the 1-year clinical outcomes and disc degeneration rates after transforaminal full-endoscopic lumbar discectomy (TF-FED), condoliase injection, open discectomy (OD), and microendoscopic discectomy (MED) for lumbar disc herniation (LDH). In total, 279 patients with LDH were divided into four treatment groups: TF-FED, OD, MED, and condoliase injection. Outcomes were evaluated on the basis of the complication rate, Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ), visual analog scale (VAS) scores, and the modified MacNab criteria. Surgical and hospital costs were assessed. Disc degeneration and endplate bone marrow edema were evaluated using magnetic resonance images. The mean postoperative JOABPEQ, VAS, or modified MacNab scores among the four groups had no significant differences. Additionally, the nerve injury or reoperation rate among the TF-FED, OD, and MED groups had no significant difference. However, the reoperation rate with condoliase injection was high because of residual disc herniation. Surgical and hospital costs were lower with condoliase injection and higher with OD and MED than those with TF-FED. With TF-FED and condoliase injection, the Pfirrmann grade progressed, and the disc height was significantly smaller than that with OD and MED. Endplate bone marrow edema was more common with condoliase injection and TF-FED. All groups had good outcomes. TF-FED and condoliase injection may reduce the burden of surgery because they can be performed under local anesthesia with little blood loss and low medical costs but tend to be associated with disc degeneration and endplate bone marrow edema. A randomized controlled study with a larger sample is needed.

Object: Evaluation of the impact of patients' participation on postoperative recovery and satisfaction who underwent the Percutaneous Endoscopic Interlaminar Discectomy(PEID)., Methods: We collected data from sixty-nine patients who underwent PEID surgery at Chuzhou Chinese and Western Medicine Hospital between January 2020 and December 2022. All patients had L5/S1 lumbar disc herniation and met the inclusion and exclusion criteria. The patients were divided into two groups: non-communication group (n = 33) and communication group (n = 36). The division was made based on whether the patients had preoperative surgical video viewing and intraoperative communication. We compared the baseline data, surgical time, VAS score, lumbar JOA score, surgical complications, and patient satisfaction between the two groups., Result: The communication group showed better pain control and functional recovery in the early postoperative period. The communication group had better VAS scores on the first day and month after surgery, as well as JOA scores on the first week and month after surgery, with statistically significant differences (P < 0.05). There was no significant difference in hospital stay, VAS score, JOA score, and postoperative complications between the two groups of patients at 3 and 6 months after surgery. The communication group had higher patient satisfaction (P < 0.05)., Conclusion: Preoperative surgical video viewing and intraoperative communication by PEID patients can alleviate pain, accelerate functional recovery, improve symptoms, and increase patients' satisfaction. We need to do more work to develop this new model., (© 2024. The Author(s).)

Purpose: This study aimed to assess the clinical effectiveness and safety of percutaneous endoscopic interlaminar discectomy (PEID) in the management of high-grade migrated Lumbar disc herniation (LDH)., Methods: A total of 328 patients who underwent PEID for high-grade migrated LDH between May 2020 and January 2023 in our hospital were selected. Patients were categorized into high-grade migrated group and low-grade migrated group according to preoperative MRI findings. The preoperative and postoperative evaluations of clinical outcomes, such as Visual Analogue Scale (VAS) for lower backs and legs, Oswestry Disability Index (ODI), and modified MacNab criteria for surgical success, were compared between groups., Results: No statistically significant differences were found in hospitalization time, surgery time, intraoperative hemorrhage, number of intraoperative fluoroscopies, or incision length between the two groups. The lower back and leg VAS scores and ODI exhibited a statistically significant decrease in both groups across all postoperative time intervals. However, the difference between the two groups was not statistically significant. Postoperative nerve root stimulation symptoms were reported in two and three cases in the high-grade migrated group and low-grade migrated group, respectively. One patient in the high-grade migrated group underwent reoperation due to re-herniation at the same segment. There was no significant difference in the rate of excellent-good cases between the two groups, with an overall rate of 94.7%., Conclusion: In treating high-grade migrated disc herniation, PEID offers advantages such as reduced trauma, small incision, quicker recovery and satisfactory clinical safety and efficacy., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)

Objective: The purpose of this study was to investigate the long-term consequences on the cervical spine after Anterior transcorporeal percutaneous endoscopy cervical discectomy (ATc-PECD) from the biomechanical standpoint., Methods: A three-dimensional model of the normal cervical spine C2-T1 was established using finite element method. Subsequently, a disc degeneration model and degeneration with surgery model were constructed on the basis of the normal model. The same loading conditions were applied to simulate flexion, extension, lateral bending and axial rotation of the cervical spine. We calculated the cervical range of motion (ROM), intradiscal pressure, and intravertebral body pressure under different motions for observing changes in cervical spine biomechanics after surgery. At the same time, we combined the results of a long-term follow-up of the ATc-PECD, and used imaging methods to measure vertebral and disc height and cervical mobility, the Japanese Orthopaedic Association (JOA) score and visual analog scale (VAS) score were used to assess pain relief and neurological functional recovery., Results: The long-term follow-up results revealed that preoperative JOA score, neck VAS score, hand VAS score, IDH, VBH, and ROM for patients were 9.49 ± 2.16, 6.34 ± 1.68, 5.14 ± 1.48, 5.95 ± 0.22 mm, 15.41 ± 1.68 mm, and 52.46 ± 9.36° respectively. It changed to 15.71 ± 1.13 (P < 0.05), 1.02 ± 0.82 (P < 0.05), 0.77 ± 0.76 (P < 0.05), 4.73 ± 0.26 mm (P < 0.05), 13.67 ± 1.48 mm (P < 0.05), and 59.26 ± 6.72° (P < 0.05), respectively, at 6 years postoperatively. Finite element analysis showed that after establishing the cervical spondylosis model, the overall motion range for flexion, extension, lateral bending, and rotation decreased by 3.298°, 0.753°, 3.852°, and 1.131° respectively. Conversely, after establishing the bone tunnel model, the motion range for these actions increased by 0.843°, 0.65°, 0.278°, and 0.488° respectively, consistent with the follow-up results. Moreover, analysis of segmental motion changes revealed that the increased cervical spine mobility was primarily contributed by the surgical model segments. Additionally, the finite element model demonstrated that bone tunneling could lead to increased stress within the vertebral bodies and intervertebral discs of the surgical segments., Conclusions: Long-term follow-up studies have shown that ATc-PECD has good clinical efficacy and that ATc-PECD can be used as a complementary method for CDH treatment. The FEM demonstrated that ATc-PECD can lead to increased internal stresses in the vertebral body and intervertebral discs of the operated segments, which is directly related to cervical spine degeneration after ATc-PECD., (© 2024. The Author(s).)

Percutaneous lumbar nucleoplasty (PLN) and intradiscal electrothermal therapy (IDET) are effective treatment options for discogenic low back pain (D-LBP). We evaluated the effectiveness of PLN and IDET and the positive predictive factors associated with intradiscal procedures. We reviewed the medical records of 205 patients who underwent IDET or PLN in patients with D-LBP followed by positive provocation discography. A successful outcome was defined as ≥ 50% pain relief on the numerical rating scale (NRS) pain score at the 6-month follow-up visit. The relationship between the outcome of the intradiscal procedure and clinical variables was investigated using multivariate analyses. Of the 142 patients (89 with PLN and 53 with IDET), 86 (60.5%) experienced a successful outcome, which was more substantial in PLN (n = 61, 68.5%) than in IDET (n = 25, 47.2%; P = .010). The high-grade Modified Dallas Discogram Scale in provocation discography and a procedure at the L3/L4 spinal level were independent positive predictors of successful outcomes (P = .023 and .010, respectively). Coexisting psychiatric disorders, such as depression and anxiety, were negative predictors of successful treatment (P = .007). No serious complications related to the intradiscal procedures were reported during the 6-month follow-up period. PLN and IDET might be effective for managing low back pain (LBP) from internal disc disruption (IDD). The high-grade Modified Dallas Discogram, a procedure at the L3/4 spinal level, and the absence of neuropsychiatric disorders could be positive factors for the successful outcome of the intradiscal procedure., Competing Interests: The authors have no funding and conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Objective: Currently, there is no established guideline on whether to opt for percutaneous endoscopic lumbar discectomy (PELD) or traditional transforaminal lumbar interbody fusion (TLIF) surgery based on specific types of lumbar disc herniation (LDH). Based on the Michigan State University (MSU) classification system, this study conducted a medium- to long-term follow-up analysis of two surgical methods over 5 years for the first time, aiming to provide empirical evidence to assist in making more informed decisions before surgery for LDH treatment., Methods: This was a retrospective study that included 273 patients with single-level LDH who underwent PELD or TLIF treatment at our hospital between January 1, 2016, and December 31, 2018. Detailed metrics included preoperative and postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) at 1-day, 1-week, 1-year, and 5-year follow-ups. Complications, recurrences, and 5-year postoperative modified MacNab criteria scores were also recorded. Statistical methods included independent sample t-tests, repeated measures analysis of variance (ANOVA), and χ 2 tests., Results: Classified into seven groups according to the MSU classification, it was found that there was an improvement in the VAS and ODI scores at four postoperative follow-ups (p < 0.001). PELD showed better results than TLIF in reducing pain and improving the ODI scores in the classifications of 3B, 2B, and 2C (p < 0.05). TLIF demonstrated consistent superiority over PELD in 2A, 2AB, 3A, and 3AB classifications (p < 0.05). The total recurrence rate in the PELD group (11.05%) within 5 years after surgery was higher (p < 0.05) than that in the TLIF group (3.96%). These were mainly concentrated in the 2A, 2AB, 3A, and 3AB types. Moreover, the rate of excellent and good outcomes in the PELD was higher than in the TLIF but no significant difference (χ 2  = 1.0568, p = 0.5895)., Conclusion: This study suggests that PELD and TLIF may relieve LDH, but have advantages under different MSU classifications. The MSU classification has specific guiding significance and could aid in the surgical selection of PELD or TLIF to achieve optimal treatment outcomes for patients with lumbar disc herniation., (© 2024 The Author(s). Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Background and Objectives: Percutaneous endoscopic lumbar diskectomy (PELD) is an effective, minimally invasive method for removal of lateral lumbar disk herniations. This minimally invasive technique can be applied with high success and lead to faster recovery than traditional methods. Unfortunately, adoption of these techniques in the United States has been slow. A significant barrier to using this technique is often an inability to completely visualize relevant anatomy and increased operative times. In this article, we describe a technique using computed tomography (CT) guidance in conjunction with a neurogram to perform a PELD. We detail the steps in the technique and its advantages to the surgeon performing it., Methods: After a patient is placed supine on a table, a transforaminal injection of contrast is performed under fluoroscopic guidance. Then, after sterilizing and draping in a normal fashion, an intraoperative CT scan is taken with a reference frame in place. During the procedure, this allows for the CT guidance to have the exiting nerve root clearly outlined., Results: This procedure was successfully performed in a single patient, allowing greater visualization of the exiting nerve root during a difficult revision PELD case. No complications were experienced., Conclusion: A novel technique using a neurogram with CT guidance during a PELD was used to assist with identification of anatomy and decompression of the exiting nerve root. This technique was used without complications., (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)

Background: Management of anterior cervical corpectomy and fusion (ACCF)-derived adjacent segment disease (ASD) represented a challenge facing the surgeons., Methods: A 41-year man diagnosed as C3-4 level ASD derived from C5-level ACCF surgery 13 years ago was admitted to the hospital for numbness and pain in the right shoulder and upper limb. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) was performed, and pre- and postoperative clinical and imaging data were collected., Results: The operation was completed within 70 min, and no clinical or radiological complication was reported. The visual analog scale (VAS) score decreased from preoperative 5 points to postoperative 1 point. Numbness was relieved postoperatively and disappeared completely at postoperative 3 months. Imaging data indicated sufficient spinal cord decompression, good channel repairing and cervical alignment., Conclusions: Channel-repairing PEATCD was successfully performed to treat ACCF-derived ASD, nevertheless, the long-term efficacy remained tracing and further clinical trials were needed to validate its efficacy., (© 2024. The Author(s).)

Background: This study aimed to evaluate the effect of foraminoplasty using large-channel endoscopy during TESSYS on the biomechanics of the lumbar spine., Methods: A complete lumbar spine model, M1, was built using 3D finite elements, and models M2 and M3 were constructed to simulate the intraoperative removal of the superior articular process of L5 using a trephine saw with diameters of 5 mm and 8.5 mm, respectively, and applying normal physiological loads on the different models to simulate six working conditions-anterior flexion, posterior extension, left-right lateral bending, and left-right rotation-to investigate the displacement and facet joint stress change of the surgical segment, and the disc stress change of the surgical and adjacent segments., Results: Compared with the M1 model, the M2 and M3 models showed decreased stress at the L4-5 left FJ and a significant increase in stress at the right FJ in forward flexion. In the M2 and M3 models, the L4-5 FJ stresses were significantly greater in left lateral bending or left rotation than in right lateral bending or right rotation. The right FJ stress in M3 was greater during left rotation than that in M2, and that in M2 was greater than that in M1. The L4-5disc stress in the M3 model was greater during posterior extension than that in the M1 and M2 models. The L4-5disc stress in the M3 model was greater in the right rotation than in the M2 model, and that in the M2 model was greater than that in the M1 model., Conclusion: Foraminoplasty using large-channel endoscopy could increase the stress on the FJ and disc of the surgical segment, which suggested unnecessary and excessive resection should be avoided in PTED to minimize biomechanical disruption., (© 2024. The Author(s).)

Background: This study investigated the optimal concentration of ropivacaine epidural anesthesia for clinical use in percutaneous transforaminal endoscopic discectomy (PTED) by comparing the effects of different concentrations., Methods: Seventy patients scheduled for their first PTED procedure were enrolled in this randomized controlled trial. Patients were randomized to receive ropivacaine at varying concentrations (0.3% or 0.4%). Primary outcome measures included the numeric rating scale (NRS) and hip extension level (HEL). Secondary outcome measures included intraoperative fentanyl dosage and postoperative complications., Results: One patient withdrew due to severe postoperative complications. The remaining 69 patients were allocated to the 0.3% (n = 34) and 0.4% (n = 35) groups, respectively. Baseline characteristics showed no significant differences between the two groups (P > 0.05). The NRS score was significantly lower in the 0.4% group than in the 0.3% group (P < 0.01), whereas the HEL score was significantly higher (P < 0.001). The average fentanyl dose in the 0.4% group was significantly lower than that in the 0.3% group (P < 0.01). Postoperative complications occurred in five and two patients in the 0.3% and 0.4% groups, respectively., Conclusion: Although 0.4% ropivacaine (20 mL) impacts muscle strength, it does not impede PTED surgery. Given its effective analgesic properties and few postoperative complications, 0.4% ropivacaine can be considered a preferred dose for PTED., Trial Registration: This study was registered with the Chinese Clinical Trials Registry (Registration number: ChiCTR2200060364; Registration Date: 29/5/2022) and on chictr.org.cn ( https://www.chictr.org.cn/showproj.html?proj=171002 )., (© 2024. The Author(s).)

Background: Percutaneous endoscopic transforaminal discectomy (PETD) is an effective method for treating lumbar disc herniation, and is typically performed under local anesthesia. However, inadequate analgesia during the procedure remains a concern, prompting the search for a medication that can provide optimal pain control with minimal impact on the respiratory and circulatory systems., Objectives: The aim of this study was to observe the effects of different doses of esketamine combined with dexmedetomidine on reducing visual analog scale (VAS) scores during surgical interventions., Methods: One hundred two patients who underwent PETD were randomly divided into a control group (group C: normal saline + dexmedetomidine), an E1 group (0.1 mg kg -1 esketamine + dexmedetomidine), and an E2 group (0.2 mg kg -1 esketamine + dexmedetomidine). The primary outcome was the maximum visual analogue scale (VAS) (score: 0 = no pain and 10 = worst pain) at six time points. The secondary outcomes included the Assessment of Alertness/Sedation Scale (OAA/S) score and mean arterial pressure (BP), heart rate (HR), respiratory rate (RR), and oxygen saturation (SpO 2 ) at 11 time points. The incidence of adverse reactions during and 24 h after the operation and patient satisfaction with the anesthesia were also recorded., Results: Compared with those in group C, the VAS scores of patients in groups E1 and E2 were lower at T 6 , T 7 , and T 9 (P < 0.05). From T 4 to T 10 , the OAA/S scores of the E1 and E2 groups were both lower than those of group C (P < 0.05), and at the T 4 -T 6 time points, the OAA/S score of the E2 group was lower than that of group E1 (P < 0.05). At T 4 and T 5 , the HR and BP of patients in groups E1 and E2 were greater than those in group C (P < 0.05). Compared with those in group C, the incidences of intraoperative illusion, floating sensation, postoperative dizziness, and hyperalgesia in groups E1 and E2 were significantly greater (P < 0.01). There was no significant difference in patient RR, SpO 2 , or postoperative satisfaction with anesthesia among the three groups (P > 0.05)., Conclusion: The combination of esketamine and dexmedetomidine can reduce VAS scores during certain stages of this type of surgery; it has minimal impact on respiration and circulation. However, this approach is associated with increased incidences of postoperative dizziness and psychiatric side effects, which may also affect patients' compliance with surgical instructions from medical staff. Patient satisfaction was not greater with dexmedetomidine combined with esketamine than with dexmedetomidine alone., Trial Registration: http://www.chictr.org.cn . Identifier: ChiCTR2300068206. Date of registration: 10 February 2023., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Objective: This study aimed to investigate the clinical efficacy of percutaneous endoscopic suprapedicular decompression in treatment of down-migrated lumbar disc herniation., Methods: The clinical data of 43 patients with down-migrated lumbar disc herniation treated with endoscopic surgery at our hospital between January 2022 and January 2023 were retrospectively analyzed. Twenty-two and 21 patients underwent percutaneous endoscopic decompression using the suprapedicular and transforaminal endoscopic surgical system approaches, respectively. The perioperative, follow-up, and imaging data of the groups were compared., Results: Surgery was uneventful in both groups. The number of intraoperative fluoroscopies and duration of surgery were significantly lower in the suprapedicular group (P < 0.05). The patients in both groups were followed up for at least 12 months. At the last follow-up, lumbar pain and leg pain visual analog scale, Oswestry Disability Index, and 36-Item Short Form Health Survey scores were significantly improved in both groups compared with preoperative values (P < 0.05); the differences in these indexes between the 2 groups were not significant preoperatively (P > 0.05). However, at the last postoperative follow-up, lumbar pain visual analog scale scores were significantly better in the suprapedicular group (0.83 ± 0.85 vs. 2.54 ± 1.32, P < 0.05). There was no significant change in intervertebral space height or lumbar lordotic angle compared with preoperative values in either group at the last follow-up (P > 0.05). However, the spinal canal cross-sectional area significantly increased (P < 0.05)., Conclusions: The treatment of down-migrated lumbar disc herniation via a suprapedicular approach enabled the incision of the superior margin of the pedicle as needed under direct vision, involved less fluoroscopy while preserving facet joint stability, and enabled targeted removal of the herniated nucleus pulposus, thus greatly reducing residual nucleus pulposus. This surgical procedure was safe, rapid, and showed satisfactory therapeutic efficacy., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Percutaneous transforaminal endoscopic discectomy (PTED) has steep learning curves and a high incidence of complications, but currently, efficient and economical training methods are lacking. This study aimed to validate a novel simulator for PTED., Methods: The simulated PTED included puncturing and establishing the working channel (PEWC) and endoscopic discectomy, with the PEWC being the tested module. Eleven experts and 21 novices were included and introduced to the simulator and tasks; all participants completed the PEWC. Outcomes included: total operation time, number of fluoroscopy for positioning the working sheath, number of spinal risk region invasion, Global Rating Scale (GRS) and a modified GRS, etc. The Mann-Whitney U test was used to compare 2 groups. Spearman's correlation coefficient analyzed continuous variables., Results: Experts outperformed novices in total operation time (P = 0.001), requiring fewer number of fluoroscopies for positioning the working sheath (P = 0.003). Additionally, experts had a lower number of spinal risk region invasions (P = 0.016) and higher scores on both the GRS (P < 0.001) and modified GRS (P < 0.001). PTED experience correlated with GRS scores (P = 0.001) and modified GRS (P < 0.001). The overall realism scored a median of 4 (3.75-5), and educational value had a median of 4 (range 3-5)., Conclusions: This study demonstrates the validity of the novel simulator, revealing significant associations between PTED experience and performance metrics in a simulated PEWC setting. Furthermore, the PEWC module also offers a good realistic design and high education value according to experts., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Lumbar disc herniation (LDH) remains one of the extremely common diseases in the elderly population, and despite the fact that percutaneous transforaminal endoscopic discectomy (PTED) can be an effective treatment for LDH, prognostic recurrence of the patients is still a clinical problem that needs to be addressed., Objective: To perform a meta-analysis of the influencing factors of disease recurrence after PTED for LDH to provide evidence for clinical practice., Methods: By screening the PubMed, EMbase, and Cochrane Library databases for relevant studies on disease recurrence after PTED for LDH, we extracted the authors, publication time, outcome measures, and other indicators were extracted for meta-analyses using RevMan 5.3 software., Results: The online retrieval and rigorous screening returned 8 valid articles for analysis, all with high reference value, as their Newcastle Ottawa Scale (NOS) scores were above 6. According to meta-analyses, there were no differences in gender and LDH type and location among patients with LDH recurrence after PTED treatment (P > .05); however, statistical significance was present in Pfirrmann grading, incomplete nucleus pulposus removal during surgery, and Modic changes (P < .05), indicating that these indexes were the influencing factors of LDH recurrence., Conclusions: Pfirrmann grading, incomplete nucleus pulposus removal during surgery, and Modic changes are related factors affecting LDH recurrence after PTED.

Objectives: To observe the clinical efficacy and safety of ultrasound-guided acupotomy in adjuvant treatment of residual symptoms after percutaneous cervical disc nucleoplasty (PCDN) for cervical spondylotic radiculopathy (CSR)., Methods: A total of 70 CSR patients were divided into treatment group and control group according to random number table, with 35 cases in each group. Patients in the control group received PCDN, while patients in the treatment group further received ultrasound-guided acupotomy, which was performed once every 5 to 7 days for a total of 4 to 6 times (adjusted according to the condition of patients). The visual analog score (VAS), neck dysfunction index (NDI), Japanese Orthopaedic Association cervical spondylosis scale (JOA score), and Tanaka Yasuhisa 20-point scale were adopted in the assessment before PCDN and 1 day, 1 month, 3 months, 6 months after PCDN. The clinical efficacy, postoperative adverse reactions and complications of the 2 groups were evaluated., Results: Compared with those before PCDN, the VAS score and NDI score of the 2 groups were decreased ( P <0.05), JOA score and Tanaka Yasuhisa 20-point score were increased ( P <0.05) at 1 day and 1, 3 and 6 months after surgery. Compared with same group 1 day after surgery, the VAS score and NDI score of the treatment group were decreased ( P <0.05), while JOA score and Tanaka Yasuhisa 20-point score were increased ( P <0.05) at 1, 3 and 6 months after surgery. Compared with the control group at the same time points, the VAS score and NDI score of the treatment group were decreased ( P <0.05), while JOA score and Tanaka Yasuhisa 20-point score were increased ( P <0.05) at 1, 3 and 6 months after operation. The effective rate and excellent rate of the treatment group 1, 3 and 6 months after PCDN were higher than those of the control group ( P <0.05). Follow-up to 1 year after surgery, no significant postoperative adverse reactions and complications were found in both groups., Conclusions: Ultrasound-guided acupotomy can significantly improve the residual symptoms after PCDN for CSR patients, and the clinical efficacy is significantly better than that of PCDN alone, and this therapy is safe and reliable.

Introduction: Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC) of ropivacaine concentration for epidural anaesthesia, is defined as the concentration that minimises pain while preserving the sensation of the nerve roots. This distinct advantage allows the patient to provide feedback to the surgeon when the nerve roots are contacted., Methods: We used a biased-coin design to determine the MTC, which was estimated by the 10% effective concentration (EC 10 ), ie, the concentration at which 10% of patients lost sensation in the nerve roots. The determinant for positive response was lack of sensory feedback upon contact with the nerve root, and the feedback from occurrence of sensations in the innervation area upon contact with the nerve root was defined as a negative response. Primary outcome was the response from contact nerve root. Secondary outcomes were the type and number of statements of negative response and each patient's pain score during surgery., Results: Fifty-four patients were included in this study. The EC 10 was 0.434% (95% CI: 0.410%, 0.440%) using isotonic regression in comparison with 0.431% (95% CI: 0.399%, 0.444%) using probit regression. Three type statements of negative response were reported including "tactile sensation", radiculalgia, and numbness., Conclusion: The MTC of ropivacaine used for epidural anaesthesia was 0.434% to avoid nerve injury in percutaneous endoscopic transforaminal lumbar discectomy., Competing Interests: The authors report no competing interests in this work., (© 2024 Hu et al.)

Background: Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of patients with ULDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) compared with those with lower LDH., Methods: 60 patients with ULDH or L4-L5 LDH treated with PTED between May 2016 and October 2021. MacNab criteria, visual analog scale (VAS) of back pain and leg pain, and Japanese Orthopedic Association (JOA) were evaluated before and after surgery., Results: In the L1-L3 group, 59.1% of the patients had a positive femoral nerve tension test, and 81.8% of the patients had a sensory deficit. Both groups showed significant improvements in VAS scores for low back and leg pain, and JOA scores postoperatively. No significant differences in the degree of improvement were observed between the two groups. The excellent/good rate was 81.8% in the L1-L3 group and 84.2% in the L4-L5 group, showing no significant difference., Conclusion: PTED has comparable efficacy in treating ULDH as it does in treating lower LDH, it is a safe and effective treatment method for ULDH., (© 2024. The Author(s).)

Background: Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated efficacy in alleviating leg pain among patients with lumbar disc herniation. Nonetheless, residual back pain persists as a troubling issue for surgeons following the procedure. In the treatment of discogenic back pain, sinuvertebral nerve radiofrequency ablation has shown promising results. Nevertheless, the potential benefit of simultaneously implementing sinuvertebral nerve radiofrequency ablation during PELD surgery to address residual back pain has not been thoroughly investigated in current literature., Methods: This retrospective study reviewed Lumbar disc herniation (LDH) patients with low back pain who underwent combined PELD and sinuvertebral nerve ablation in our department between January 2021 and September 2023. Residual low back pain post-surgery was assessed and compared with existing literature., Results: A total of 80 patients, including 53 males and 27 females, were included in the study. Following surgical intervention, patients demonstrated remarkable improvements in pain and functional parameters. One month post-operatively, the VAS score for low back pain exhibited a 75% reduction (6.45 ± 1.3 to 1.61 ± 1.67), while the VAS score for leg pain decreased by 85% (7.89 ± 1.15 to 1.18 ± 1.26). Notably, the JOA score increased from 12.89 ± 5.48 to 25.35 ± 4.96, and the ODI score decreased form 59.48 ± 9.58 to 20.3 ± 5.37. These improvements were sustained at three months post-operatively. According to the modified Mac Nab criteria, the excellent and good rate was 88.75%. Residual low back pain is observed to be comparatively reduced compared to the findings documented in earlier literature., Conclusion: The combination of percutaneous endoscopic lumbar discectomy and sinuvertebral nerve ablation demonstrates effective improvement in low back pain for LDH patients., (© 2024. The Author(s).)

Objective: The purpose of this study was to investigate the learning curve of percutaneous endoscopic transforaminal discectomy (PETD) and interlaminar unilateral biportal endoscopic discectomy (UBED) in the treatment of lumbar disc herniation (LDH)., Methods: Between 2018 and 2023, 120 consecutive patients with lumbar disc herniation (LDH) treated by endoscopic lumbar discectomy were retrospectively included. The PETD group comprised 87 cases, and the UBED group comprised 33 cases. Cumulative sum analysis was used to evaluate the learning curve, with the occurrence of complications or unresolved symptoms defined as surgical failure, and variables of different phases of the learning curve being compared., Results: The learning curve analysis identified the cutoff point at 40 cases in the PETD group and 15 cases in the UBED group. In the mastery phase, both PETD and UBED demonstrated a significant reduction in operation times (approximately 38 min for PTED and 49 min for UBED). In both PETD and UBED groups, the surgical failure rates during the learning and mastery phases showed no statistically significant differences. The visual analogue scale at the last follow-up was significantly lower than before surgery in both the PETD and UBED groups., Conclusion: PETD and UBED surgery are effective in the treatment of LDH with a low incidence of complications. However, achieving mastery in PETD necessitates a learning curve of 40 cases, while UBED requires a minimum of 15 cases to reach proficiency., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The reported date in the repeat surgical intervention for adolescent lumbar disc herniation (ALDH) after percutaneous endoscopic lumbar discectomy (PELD) was quite scarce. This study aims to introduce cases of repeat surgeries after PELD for ALDH and assess the incidence, chief causes, repeat surgery methods, and surgical outcomes of repeat surgeries after PELD for ALDH., Methods: A retrospective multicenter observational study was conducted on patients undergoing repeat surgeries after PELD for ALDH at four tertiary referral hospitals from January 2014 through August 2022. The incidence of repeat surgeries, chief causes, strategies for repeat surgeries, and timing of repeat surgeries were recorded and analyzed. The clinical outcomes were evaluated by the Numeric Rating Scales (NRS) scores and the modified MacNab criteria. Statistical analyses were performed with the Wilcoxon signed-rank test., Results: A total of 23 patients who underwent repeat surgeries after PELD for ALDH were included. The chief causes were re-herniation (homo-lateral re-herniation at the same level, new disc herniation of adjacent level). The repeat surgery methods were revision PELD, micro-endoscopic discectomy (MED), open discectomy and instrumented lumbar inter-body fusion. The NRS scores decreased significantly in follow-up evaluations and these scores demonstrated significant improvement at the last follow-up (p < 0.002). For the modified MacNab criteria, at the last follow-up, 18 patients (78.26%) had an excellent outcome, and the overall success rate was 86.95%., Conclusion: This study's data suggest that young patients who underwent repeat surgery improved significantly compared to baseline. The chief cause was re-herniation. Revision PELD was the main surgical procedure, which provides satisfactory clinical results in young patients who underwent repeat surgeries., (© 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Background: To investigate the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of patients who were diagnosed with lumbar disc herniation (LDH) with positive nerve root sedimentation sign (NRSS)., Methods: A total of 86 patients who underwent LDH were recruited and divided into NRSS-positive group ( n  = 49) and NRSS-negative group ( n  = 37). The visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry disability index (ODI) were used to evaluate the low back pain and functional recovery and were compared between the two groups., Results: There were no significant differences in the demographic parameters between the two groups. The average area of the dural sac compression in the NRSS-positive group was significantly higher than that in the NRSS-negative group. Patients with a positive NRSS showed a better low back pain relief than those with a negative NRSS at 1 week and 1 month after surgery. The JOA and ODI in the NRSS-positive group were better than those in the NRSS-negative group at 3 months and 6 months postoperatively. The apparent efficiency of JOA and the excellent and good rate of ODI in the negative group was lower than that in the positive group at 6 months after surgery., Conclusions: Patients undergoing LDH with a positive NRSS showed better pain relief and functional recovery than those with a negative NRSS. The present study suggested that NRSS might be a valuable sign and associated with better clinical outcomes in patients undergoing LDH with the treatment of PTED.

To explore the risk factors for residual symptoms following percutaneous endoscopic lumbar discectomy (PELD). A retrospective case-controlled study. From January 2015 to December 2020, consecutive patients who underwent PELD for lumbar disc herniation (LDH) in our department were retrospectively studied. All the patients were followed-up at least two years. Residual symptoms were analyzed for association with baseline data, clinical feature, physical examination, and radiographic characteristics, which were used to detected the risk factors. A total of 339 patients were included in this study, with a mean follow-up of 28.7 ± 3.6 months. Of the enrolled patients, 90 (26.5%) patients experienced residual low back pain (LBP), and 76 (22.4%) patients experienced leg numbness (LN). Multivariate logistic regression analysis revealed that intervertebral disc calcification on CT scans (odd ratio, 0.480; 95% confidence interval: 0.247 ~ 0.932; P < 0.05) was independent risk factor for postoperative residual LBP with odd ratio and longer symptom duration was risk factor for postoperative residual LN (odd ratio, 2.231; 95% confidence interval:1.066 ~ 4.671; P < 0.05). Residual symptoms following transforaminal endoscopic surgery are quite prevalent. Intervertebral disc calcification is a protective factor for residual low back pain, and a longer symptom duration is a risk factor for residual leg numbness., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To compare the clinical and radiological outcomes of limited discectomy (LD) and aggressive discectomy (AD) performed via spinal endoscopy using the transforaminal approach in patients with lumbar disc herniation(LDH) METHODS: We conducted a retrospective review of patients who underwent percutaneous endoscopic transforaminal discectomy (PETD) at the L4-L5 lumbar spine segments in our department from January 2017 to December 2020. The follow-up period extended to 24 months postoperatively. Patients were categorized into the LD and AD groups based on the extent of intraoperative disc removal. We retrospectively collected and analyzed clinical and radiological data., Results: The study followed 65 patients, with 36 in the LD group and 29 in the AD group. No statistically significant differences were noted in recurrence rates, the excellent and good Macnab rates, preoperative Disc Height Index (DHI), and preoperative Modic changes between the groups (P >0.05). However, significant differences were observed in operation duration, postoperative DHI and postoperative Modic change (P<0.05). No significant differences in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were detected between the groups preoperatively, or one and two years postoperatively (P>0.05). Nevertheless, notable differences in VAS and ODI scores were present one month postoperatively (P<0.05)., Conclusion: As a conventional surgical method for treating LDH, PETD can achieve satisfactory clinical results in both LD and AD, with no significant variance in recurrence rates. However, AD is associated with longer operation times, and greater postoperative reductions in DHI and greater postoperative Modic changes compared to LD., (© 2024. The Author(s).)

Objective: Compared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain, so it has been widely used in the field of spinal surgery. However, it still has the defect of intraoperative fluoroscopy occurrences, complications, and even the risk of damage to the spinal cord and nerve. This study aims to compare the clinical efficacy of modified percutaneous endoscopic interlaminar discectomy (MPEID) with percutaneous endoscopic transforaminal discectomy (PETD) in treating L4/5 lumbar disc herniation (LDH) and to evaluate the effectiveness and safety of MPEID., Methods: Thirty-four L4/5 LDH patients treated at the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were studied retrospectively. Seventeen underwent MPEID and seventeen PETD. Variables analyzed included demographics, operative duration, intraoperative fluoroscopy occurrences, and surgical outcomes. Effectiveness was evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. Lumbar Magnetic Resonance Imaging (MRI) was used to assess radiological outcomes. A paired t-test was performed to compare intragroup pre- and postoperative clinical data, VAS, and ODI scores., Results: The average operative time in PETD group was 91.65 ± 14.04 min, and the average operative time in MPEID group was 65.41 ± 12.61 min (p < 0.001). In PETD group, the fluoroscopy occurrences averaged 9.71 ± 1.05 times, with fluoroscopy occurrences averaging 6.47 ± 1.00 times (p < 0.001) in MPEID group. At 12 months follow-up, the clinical effect showed significant improvement in both two groups. The MPEID group showed a decrease in average VAS-back score from 5.41 ± 2.18 to 1.76 ± 1.09 (p < 0.001) and VAS-leg score from 6.53 ± 1.66 to 0.82 ± 0.64 (p < 0.001). The ODI scores decreased from 51.35 ± 10.65 to 11.71 ± 2.91 (p < 0.001). In the PETD group, the VAS-back score decreased from 4.94 ± 1.98 to 2.06 ± 1.25 (p < 0.001), VAS-leg score from 7.12 ± 1.73 to 1.12 ± 0.60 (p < 0.001), and ODI scores from 48.00 ± 11.62 to 12.24 ± 2.56 (p < 0.001). According to the modified MacNab criteria, MPEID had 15 excellent and two good results; PETD had 12 excellent and 5 good (p = 0.23). No nerve root injuries, dural tears, or significant complications were reported., Conclusion: MPEID and PETD effectively treat L4/5 LDH, with MPEID showing shorter operative times and fewer fluoroscopies. Furthermore, the MPEID group can provide excellent clinical efficacy as the PETD group in the short term., (© 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.)

Objective: Based on the previously established 3-dimensional model, this study uses the finite element analytical method to observe the effects of superior articular process resection and intervertebral discectomy on the stress of the surgical segment under different motion states., Methods: A validated L3-S1 finite element model was modified for simulation. And on the basis of the normal lumbar spine model, the superior articular process and discs of different parts of L4-L5 were simulated for resection. The resection models were divided into 6 groups, and the stress characteristics of articular process and discs of the lumbar spine under different postoperative motion conditions were examined under the same loading conditions., Results: Simultaneous resection of the tip and base of the superior articular process increased the stress on the facet joint under various motion states compared with separate resections. In addition, the fewer herniated discs that are removed, the smaller the increase in facet joint stress. excision of the tip of the superior articular process caused a smaller stress increase in the facet joint than excision of the base under the forward bending and right-lateral flexion, and the opposite results were found under left-lateral flexion, posterior extension, and rotation. Resection of the tip of the superior articular process increases disc stress more than resection of the base of the superior articular process., Conclusions: Select resection of the superior articular process base as much as possible to expose the target of the disc. And minimize annulus damage and disc removal., (Copyright © 2023. Published by Elsevier Inc.)

Percutaneous endoscopic lumbar discectomy (PELD) is one of the main means of minimally invasive spinal surgery, and is an effective means of treating lumbar disc herniation, but its early recurrence is still difficult to predict. With the development of machine learning technology, the auxiliary model based on the prediction of early recurrent lumbar disc herniation (rLDH) and the identification of causative risk factors have become urgent problems in current research. However, the screening ability of current models for key factors affecting the prediction of rLDH, as well as their predictive ability, needs to be improved. Therefore, this paper presents a classification model that utilizes wrapper feature selection, developed through the integration of an enhanced bat algorithm (BDGBA) and support vector machine (SVM). Among them, BDGBA increases the population diversity and improves the population quality by introducing directional mutation strategy and guidance-based strategy, which in turn allows the model to secure better subsets of features. Furthermore, SVM serves as the classifier for the wrapper feature selection method, with its classification prediction results acting as a fitness function for the feature subset. In the proposed prediction method, BDGBA is used as an optimizer for feature subset filtering and as an objective function for feature subset evaluation based on the classification results of the support vector machine, which improves the interpretability and prediction accuracy of the model. In order to verify the performance of the proposed method, this paper proves the performance of the model through global optimization experiments and prediction experiments on real data sets. The accuracy of the proposed rLDH prediction model is 93.49% and sensitivity is 88.33%. The experimental results show that Level of herniated disk, Modic change, Disk height, Disk length, and Disk width are the key factors for predicting rLDH, and the proposed method is an effective auxiliary diagnosis method., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: Noncontiguous 2-level cervical disc herniation (NCT-CDH) is a common condition that often requires surgical intervention. In this study, we developed a surgical approach for the treatment of NCT-CDH using anterior percutaneous full-endoscopic single incision through the vertebral body. We provide a brief overview of its safety, efficacy, and feasibility, along with a description of our relevant surgical experience., Methods: A retrospective study was conducted, involving 30 patients who were followed up for at least 12 months. Preoperative and postoperative visual analog scale, Japanese Orthopedic Association scores, Nurick scores, intervertebral disc height, and modified Macnab criteria were recorded. Patients underwent regular radiological evaluations throughout the follow-up period., Results: Postoperative computed tomography, magnetic resonance imaging, and X-ray examinations revealed bone tunnel healing, intact drilled vertebral bodies without collapse, adequate decompression of the spinal canal, and normal cervical mobility. There was a significant improvement in postoperative visual analog scale, Japanese Orthopedic Association scores, Nurick scores, and modified Macnab criteria compared to the preoperative values (P < 0.05)., Conclusions: Our study revealed that the anterior percutaneous full-endoscopic transcorporeal with single-incision treatment for NCT-CDH is a safe and feasible surgical method. Therefore, it can be considered as a viable treatment option for patients with NCT-CDH., (Copyright © 2023. Published by Elsevier Inc.)

Objective: This study aimed to evaluate the influence of herniation of cartilaginous endplates on postoperative pain and functional recovery in patients undergoing percutaneous endoscopic lumbar discectomy (PELD) for lumbar disc herniation (LDH)., Methods: A retrospective analysis was conducted on 126 patients with LDH treated with PELD at the Third Hospital of Hebei Medical University from January 2021 to January 2022. Whether cartilaginous endplates had herniated was identified by analyzing these specific findings from MRI scans: posterior marginal nodes, posterior osteophytes, mid endplate irregularities, heterogeneous low signal intensity of extruded material, and Modic changes in posterior corners and mid endplates. Patients were assessed for postoperative pain using the Visual Analogue Scale (VAS) and functional recovery using the Oswestry Disability Index (ODI) and Modified MacNab criteria. Statistical analyses compared outcomes based on the presence of herniation of cartilaginous endplates., Results: Patients with herniation of cartilaginous endplates experienced higher pain scores early postoperatively but showed significant improvement in pain and functional status over the long term. The back pain VAS scores showed significant differences between the groups with and without herniation of cartilaginous endplates on postoperative day 1 and 1 month (P < 0.05). Leg pain VAS scores showed significant differences on postoperative day 1 (P < 0.05). Modic changes were significantly associated with variations in postoperative recovery, highlighting their importance in predicting patient outcomes. In patients with herniation of cartilaginous endplates, there were statistically significant differences in the back pain VAS scores at 1 month postoperatively and the ODI functional scores on postoperative day 1 between the groups with and without Modic changes (P < 0.05). There were no significant differences in the surgical outcomes between patients with and without these conditions regarding the Modified MacNab criteria (P > 0.05)., Conclusion: Herniation of cartilaginous endplates significantly affect early postoperative pain and functional recovery in LDH patients undergoing PELD. These findings emphasize the need for clinical consideration of these imaging features in the preoperative planning and postoperative management to enhance patient outcomes and satisfaction., (© 2024. The Author(s).)

Objective: To evaluate the clinical efficacy and imaging outcomes of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) for the treatment of lumbar disc herniation (LDH)., Methods: A total of 155 patients with LDH between January 2020 and June 2022 were retrospective analyzed, of which 75 underwent PELD with PRP and 80 underwent PELD only. Clinical functional scores and imaging data were compared. Clinical functional scores included visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), Japanese Orthopedic Association score (JOA), Oswestry Disability Index (ODI) and modified MacNab criteria. Imaging data included disc height index (DHI), spinal cross-sectional area (SCSA), disc protrusion size (DPZ), and ratio value of disc grey scales (RVG)., Results: Both groups showed clinical improvement, and VAS-LP, VAS-BP, JOA and ODI were significantly improved in the PRP group compared with the control group at 3, 6 and 12 months postoperatively (P < 0.05). At the last follow-up, the differences in SCSA, DPZ and RVG between the two groups were statistically significant (P < 0.05), with the PRP group being superior to the control group. The excellent and good rates of the modified Macnab criteria in the PRP group and control group were 93.3% and 90%, respectively, with no statistically significant difference (P > 0.05). No serious complications occurred during the follow-up period., Conclusion: PELD combined with PRP is a safe and effective method for treating patients with LDH. PRP injection was beneficial for delaying disc degeneration and promoting disc remodeling., (© 2024. The Author(s).)

Background: The surgical resection of very highly migrated lumbar disc herniation (VHM-LDH) is technically challenging owing to the absence of technical guidelines. Hence, in the present study, we introduced the transforaminal endoscopic lumbar discectomy (TELD) with two-segment foraminoplasty to manage VHM-LDH and evaluated its radiographic and midterm clinical outcomes., Materials and Methods: The present study is a retrospective analysis of 33 consecutive patients with VHM-LDH who underwent TELD with two-segment foraminoplasty. The foraminoplasty was performed on two adjacent vertebrae on the basis of the migration direction of disc fragments to fully expose the disc fragments and completely decompress the impinged nerve root. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. Additionally, imageological observations were evaluated immediately after the procedure via magnetic resonance image and computerized tomography. Clinical outcomes were evaluated by calculating the visual analog scale (VAS) score and Oswestry Disability Index (ODI). The MacNab criterion was reviewed to assess the patients' opinions on treatment satisfaction. The resection rate of bony structures were quantitatively evaluated on postoperative image. The segmental stability was radiologically evaluated at least a year after the surgery. Additionally, surgery-related and postoperative complications were evaluated., Results: The average age of the patients was 56.87 ± 7.77 years, with a mean follow-up of 20.95 ± 2.09 months. The pain was relieved in all patients immediately after the surgery. The VAS score and ODI decreased significantly at each postoperative follow-up compared with those observed before the surgery (P < 0.05). The mean operation duration, blood loss, and hospital stay were 56.17 ± 16.21 min, 10.57 ± 6.92 mL, and 3.12 ± 1.23 days, respectively. No residual disc fragments, iatrogenic pedicle fractures, and segmental instability were observed in the postoperative images. For both up- and down- migrated herniation in the upper lumbar region, the upper limit value of resection percentage for the cranial SAP, caudal SAP, and pedicle was 33%, 30%, and 34%, respectively; while those in the lower lumbar region was 42%, 36%, and 46%, respectively. At the last follow-up, the satisfaction rate of the patients regarding the surgery was 97%. Surgery-related complications including dural tear, nerve root injury, epidural hematoma, iatrogenic pedicle fractures, and segmental instability were not observed. One patient (3%) suffered from the recurrence of LDH 10 months after the initial surgery and underwent revision surgery., Conclusions: The TELD with two-segment foraminoplasty is safe and effective for VHM-LDH management. Proper patient selection and efficient endoscopic skills are required for applying this technique to obtain satisfactory outcomes., (© 2024. The Author(s).)

Purpose: We aimed to evaluate the effect of cervical disc herniation (CDH) and lumbar disc herniation (LDH) on female sexual functioning before and after surgical intervention., Methods: The current study was conducted from February 2022 to February 2023. A total of 100 sexually active female patients in their reproductive phase who were diagnosed with CDH and LDH based on physical examination and previous magnetic resonance imaging (MRI) results, as well as 50 healthy females, were enrolled. The female subjects were evaluated using the validated Arabic version of the female sexual function index (ArFSFI), a 0 to 10 visual analogue scale (VAS), the Oswestry disability index (ODI) and Beck's depression index (BDI)., Results: The baseline ArFSFI domains and total scores were greatest in the controls, followed by the CDH group. The ArFSFI domains and total scores were greatest in the control group, followed by the postoperative ArFSFI domains and total scores in the cervical group. The variations in satisfaction, pain, and overall ArFSFI ratings were significant across research groups. The difference in desire, arousal, lubrication, and orgasm was substantial in the lumbosacral group, but there were no significant changes between the cervical and control groups. Postoperatively, ArFSFI domains and overall scores improved in both of the cervical and lumbar groups. Both research groups' ODI score and grade improved after surgery. Finally, both groups' BDI score and grade improved after surgery., Conclusion: Female sexual dysfunctions caused by CDH and LDH improved considerably after surgery., (© 2024. The Author(s).)