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      One‐Stage Percutaneous Endoscopic Lumbar Discectomy for Symptomatic Double‐Level Contiguous Adolescent Lumbar Disc Herniation

      research-article
      , MD, PhD 1 , , , MD, PhD 2 , , MD, PhD 1 ,
      Orthopaedic Surgery
      John Wiley & Sons Australia, Ltd
      Adolescent, Discectomy, Endoscopic, Herniation, Percutaneous

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          Abstract

          Objective

          To assess the clinical efficacy of one‐stage percutaneous endoscopic lumbar discectomy (PELD) for symptomatic double‐level contiguous adolescent lumbar disc herniation (ALDH).

          Methods

          This retrospective study included 16 patients who presented with back and/or leg pain due to double‐level disc herniation underwent PELD for symptomatic lumbar disc herniation (0.27%,16/5877) from January 2014 to September 2019. After follow‐up period of 17.3 months in average, numeric rating scale (NRS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results. Quantitative data were expressed as mean standard deviation (SD) and the data for the variation in the NRS scores before and after the operation were compared using the Wilcoxon two‐sample test. Analyses were performed with IBM SPSS Statistics for Windows, version 19.0 (IBM, Armonk, NY, USA). Values of P < 0.05 were considered significantly different.

          Results

          There were 11 male and 5 female patients, with an average age of 19.3 years (range, 15–22 years). One case affected the L 2‐ L 3 /L 3‐L 4 level, seven cases affected the L 3‐ L 4 /L 4‐ L 5 level, and eight cases affected the L 4‐ L 5 /L 5‐S 1 level. The NRS scores decreased significantly in both early and late follow‐up evaluations and these scores demonstrated significant improvement in late follow‐up ( P < 0.05). For the modified Macnab criteria, the final outcome results were excellent in 14 patients (87.5%), good in 1 patient (6.25%), fair in 1 patient (6.25%), and the overall success rate was 93.75%.

          Conclusion

          This study's data suggest that one‐stage PELD is promising treatment strategy for selected symptomatic double‐level contiguous adolescent lumbar disc herniation.

          Abstract

          Adjustment of working cannula intraoperatively for symptomatic double‐level contiguous adolescent lumbar disc herniation.

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          Most cited references27

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          Rupture of the Intervertebral Disc with Involvement of the Spinal Canal

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            Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases.

            A prospective randomized study involving 280 consecutive cases of lumbar disc herniation managed either by an endoscopic discectomy alone or an endoscopic discectomy combined with an intradiscal injection of a low dose (1000 U) of chymopapain. To compare outcome, complications, and reherniations of both techniques. Despite a low complication rate, posterolateral endoscopic nucleotomy has made a lengthy evolution because of an assumed limited indication. Chemonucleolysis, however, proven to be safe and effective, has not continued to be accepted by the majority in the spinal community as microdiscectomy is considered to be more reliable. A total of 280 consecutive patients with a primary herniated, including sequestrated, lumbar disc with predominant leg pain, was randomized. A clinical follow-up was performed at 3 months, and at 1 and 2 years after the index operation with an extensive questionnaire, including the visual analog scale for pain and the MacNab criteria. The cohort integrity at 3 months was 100%, at 1 year 96%, and at 2 years 92%. At the 3-month evaluation, only minor complications were registered. At 1-year postoperatively, group 1 (endoscopy alone) had a recurrence rate of 6.9% compared to group 2 (the combination therapy), with a recurrence rate of 1.6%, which was a statistically significant difference in favor of the combination therapy (P = 0045). At the 2-year follow-up, group 1 reported that 85.4% had an excellent or good result, 6.9% a fair result, and 7.7% were not satisfied. At the 2-year follow-up, group 2 reported that 93.3% had an excellent or good result, 2.5% a fair result, and 4.2% were not satisfied. This outcome was statistically significant in favor of the group including chymopapain. There were no infections or patients with any form of permanent iatrogenic nerve damage, and no patients had a major complication. A high percentage of patient satisfaction could be obtained with a posterior lateral endoscopic discectomy for lumbar disc herniation, and a statistically significant improvement of the results was obtained when an intradiscal injection of 1000 U of chymopapain was added. There was a low recurrence rate with no major complications. The method can be applied in any type of lumbar disc herniation, including the L5-S1 level.
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              A population-based study of juvenile disc degeneration and its association with overweight and obesity, low back pain, and diminished functional status.

              Little is known regarding juvenile disc degeneration in individuals with normal spinal alignment. Consequently, the purpose of this study was to assess the prevalence, determinants, and clinical relevance associated with juvenile disc degeneration of the lumbar spine in individuals without spinal deformities. A cross-sectional assessment of disc degeneration in juveniles was performed as part of a population-based study of 1989 Southern Chinese volunteers. Adolescents and young adults from thirteen to twenty years of age were defined as "juveniles." Juvenile subjects with no spinal deformity (n = 83) were stratified into two groups, those with and those without juvenile disc degeneration. Sagittal T2-weighted magnetic resonance images (MRI) were evaluated for the presence and extent of disc degeneration as well as other spinal findings. Demographics were assessed and clinical profiles were collected with use of standardized questionnaires. Juvenile disc degeneration was present in 35% (twenty-nine) of the juveniles without spinal deformity. Disc bulging or extrusion (p < 0.001), high-intensity zones on MRI (p = 0.040), and greater weight (p < 0.001) and height (p = 0.002) were significantly more prevalent in subjects with juvenile disc degeneration. Adjusted multivariate logistic regression modeling demonstrated that Asian-modified body-mass index (BMI) values in the overweight or obese range had a significant association with juvenile disc degeneration (odds ratio = 14.19; 95% confidence interval = 1.44 to 140.40; p = 0.023). Overweight and obese individuals had greater severity of disc degeneration than underweight and normal-weight individuals (p = 0.036). Furthermore, individuals with juvenile disc degeneration had an increased prevalence of low back pain and/or sciatica (p = 0.002), greater low back pain intensity (p < 0.001), diminished social functioning (p = 0.049), and greater physical disability (p < 0.05) than individuals without disc degeneration. The p value of <0.05 for physical disability represents both the physical function (p = 0.006) and the physical component (p = 0.032) of the SF-36. This study demonstrated that the presence of juvenile disc degeneration was strongly associated with overweight and obesity, low back pain, increased low back pain intensity, and diminished physical and social functioning. Furthermore, an elevated BMI was significantly associated with increased severity of disc degeneration. This study has public health implications regarding overweight and obesity and the development of lumbar disc disease. © 2011 by the Journal of Bone and Joint Surgery, Incorporated
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                Author and article information

                Contributors
                bobai0008@163.com
                101012005@seu.edu.cn , wuxiaotaospine@seu.edu.cn
                Journal
                Orthop Surg
                Orthop Surg
                10.1111/(ISSN)1757-7861
                OS
                Orthopaedic Surgery
                John Wiley & Sons Australia, Ltd (Melbourne )
                1757-7853
                1757-7861
                03 June 2021
                July 2021
                : 13
                : 5 ( doiID: 10.1111/os.v13.5 )
                : 1532-1539
                Affiliations
                [ 1 ] Department of Spine Surgery, Zhongda Hospital, School of Medicine Southeast University Nanjing China
                [ 2 ] Pain medicine Center Peking University Third Hospital Beijing China
                Author notes
                [*] [* ] Address for correspondence Lu Mao, MD, PhD, Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China 210009 Tel/Fax: +86‐18114705866, +86‐025‐83262330; Email: bobai0008@ 123456163.com ; Xiaotao Wu MD, PhD, Department of Spine Surgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu Province, China 210009 Tel/Fax: +86‐13605174323, +86‐025‐83262330; Email: 101012005@ 123456seu.edu.cn , wuxiaotaospine@ 123456seu.edu.cn

                Author information
                https://orcid.org/0000-0003-4868-6091
                Article
                OS13097
                10.1111/os.13097
                8313176
                34080296
                74b94fe7-2590-4dc1-a2e6-c137997612bc
                © 2021 The Authors. Orthopaedic Surgery published by Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 12 May 2021
                : 26 February 2021
                : 13 May 2021
                Page count
                Figures: 5, Tables: 2, Pages: 8, Words: 4605
                Funding
                Funded by: China postdoctoral Science Foundation , doi 10.13039/501100002858;
                Award ID: 2017T100320
                Funded by: Jiangsu Province Post Doctoral Foundation
                Award ID: 1601063C
                Categories
                Clinical Article
                Clinical Articles
                Custom metadata
                2.0
                July 2021
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.0.4 mode:remove_FC converted:26.07.2021

                adolescent,discectomy,endoscopic,herniation,percutaneous
                adolescent, discectomy, endoscopic, herniation, percutaneous

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