Objective To assess the effectiveness and safety of collagenase for intervertebral disk hernia, to facilitate the rational selection of the most appropriate therapy. Methods We searched the following electronic databases: Medline (1966 to May 2006), EMbase (1966 to May 2006), The Cochrane Library (Issue 2, 2006), CRD (Center for Reviews and Dissemination, York University), CBM (1978 to May 2006), CNKI (1994 to 2006), and VIP (1989 to 2006). RCTs or quasi-RCTs were included. RevMan 4.2 was used for statistical analysis. Results Six RCTs and one quasi-RCT involving 829 participants were included. One study showed that the short-term effective rate was similar between chemonucleolysis (CNL) and percutaneous laser dise decompression (PLDD), but the long-term effective rate of PLDD was superior to that of CNL (RR 0.35, 95%CI 0.13 to 0.96). One study revealed that the short- and long-term effective rate of CNL were higher than those of placebo (Plt;0.05). Two studies comparing collagenase vs chymopaain were heterogeneous: one indicated that chymopapain was superior to collagenase according to ITT analysis (Plt;0.05); but the other revealed no significant difference among the high- and low-dose collagenase groups and chymopapain group (Pgt;0.05). One trial showed that the effective rate between collagenase and automated percutaneous lumbar discectomy (APLD) was not significantly different (Pgt;0.05). The overall results of CNL vs Triamcinolone Acetonide showed no significant difference, but significant difference was found among patients with different types of intervertebral disk hernia. One study showed that CNL was superior to Prednisolone. Three studies reported adverse effects, mainly involving pain, neurologic deficit, cauda equina syndrome and allergic reaction amongst others. Conclusions No adequate evidence shows which therapy is more effective for intervertebral disk hernia. More high-quality trials are required.
Objective To evaluate the effectiveness and safety of different injection sites for collagenase chemonucleolysis for lumbar intervertebral disc protrusion (LIDP). Methods We searched for randomized controlled trials (RCTs) and quasi-RCTs in the following electronic databases: Pubmed (1966 to May 2006), EMBASE(1966 to May 2006), The Cochrane library (Issue 2, 2006), CRD(Center for Reviews and Dissemination),York University, CBM (1978 to May 2006 ), CNKI(1994-2006)and VIP(1989-2006). Quality assessment and data extraction were conducted by two reviewers independently. Disagreement was resolved through discussion. Results Eight studies involving a total of 1035 participants met the inclusion criteria. Meta-analysis was not carried out because of apparent heterogeneity. Four studies made comparisons among intradisc, extradisc, and combined intra- and extra-disc injection. One study (62 participants) showed that intradisc injection was superior to extradisc injection (RR 3.71, 95% CI 1.19 to 11.58, Plt;0.05). Another study (240 participants) showed that intradisc injection was superior to combined intra- and extra-disc injection after 3 months and 6 months of follow-up (RR 0.88, 95% CI 0.80 to 0.98, Plt;0.05). The other two studies showed no significant difference among intradisc, extradisc, and combined intra- and extra-disc injection. Four studies (436 participants in total) showed that amongst three extradisc injections, both anterior epidural space injection and lateral epidural space injection were superior to posterior epidural space injection (Plt;0.05). Although one study indicated that anterior epidural space injection was superior to lateral epidural space injection (RR 1.24, 95% CI 1.03 to 1.51, Plt;0.05), no statistical significance was found between anterior epidural space injection and lateral epidural space injection in two other studies (Pgt;0.05). Conclusions There is insufficient evidence to identify which injection site for collagenase is the most effective for lumbar intervertebral disc protrusion. The included studies showed that both anterior and lateral epidural space injection were superior to posterior epidural space injection. However, these studies are too small and poor quality, and have different diagnostic criteria, follow-up time points, outcome measures and efficacy parameters. Thus, more high quality and large-scale RCTs are needed.
目的 分析腰椎间盘突出症手术后复发的原因，探索有效的手术治疗方法。 方法 对2004年8月－2011年7月收治的32例腰椎间盘突出症术后复发再手术的患者，根据其病因采用3种不同手术方法治疗，其中椎间盘摘除术14例，椎间盘摘除联合腰椎后外侧融合内固定术7例，椎间盘摘除联合腰椎后路椎体间融合内固定术11例，术后应用改良Macnab疗效评定标准、Oswestry功能障碍指数（ODI）和影像学检查对手术治疗的临床疗效进行评价。 结果 3种手术治疗方法均取得了满意的优良率；术后3个月及末次随访ODI评分术后较术前明显降低，差异有统计学意义（P＜0.05）。 结论 腰椎间盘突出症术后复发与多种原因有关；根据复发患者的情况合理选择手术治疗方法均能取得较好的临床疗效。
目的:观察手法复位配合针刺治疗腰椎间盘突出症的疗效。方法:将239例确诊为腰椎间盘突出症的患者随机分为治疗组和对照组，其中治疗组120例，采用手法复位配合针刺治疗，对照组119例，采用针刺治疗。并分别观察两组患者症状评分变化和疗程。结果:治疗组总显效率85.83%，对照组72.27%（Plt;0.05）。治疗组痊愈率53.33%，对照组36.13%（Plt;0.05）。治疗组显效病例，达到显效时所需的治疗时间为12.60±3.39天，对照组为16.85±4.15天（Plt;0.05）。结论:手法复位配合针刺治疗腰椎间盘突出症优于针刺治疗。
目的：探讨在CT引导下经小关节内侧缘穿刺，应用造影剂观察药物分布，准确行靶位注射胶原酶［1］治疗术后复发的腰椎间盘突出症的疗效。方法:10例经临床确诊为腰椎间盘突出症术后复发的患者,在CT引导下经小关节内侧缘入路将穿刺针直接刺入突出物内,注射欧乃派0.5 ml，观察药物分布情况后，注入胶原酶600 u。临床观察患者术后6～12个月的治疗效果，用改良的Macnab方法评价疗效。结果:10例患者穿刺针均顺利准确刺入突出物，造影剂均匀分布在突出物及盘内。治疗优、良率为100%，无严重并发症。结论: CT引导下穿刺造影，观察造影剂的扩散后，再行靶位注射胶原酶对于术后复发的腰椎间盘突出症，可以进一步提高治疗效果，减少并发症的发生。
Objective To investigate the early effectiveness of Zero-profile interbody fusion system (Zero-P) in the treatment of cervical disc protrusion. Methods Between October 2010 and June 2012, 25 patients with cervical disc protrusion underwent anterior cervical discectomy and fusion (ACDF) using the Zero-P system. There were 15 males and 10 females, aged from 35 to 68 years (mean, 49 years). The disease duration was 3-26 months (mean, 10.5 months). Single segment was involved in all cases (2 cases in C3, 4, 5 cases in C4, 5, 11 cases in C5, 6, and 7 cases in C6, 7). The operation time and blood loss were recorded and analyzed. The visual analogue scale (VAS) score, Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used to assess pain and nerve function improvement; the cervical Cobb angle was measured on the X-ray films before and after operation; according to Pitzen’s criteria, intervertebral fusion was evaluated. Results The operation was successful in 25 patients, with no severe complication. The average blood loss was 42.6 mL (range, 20-120 mL). The average operation time was 63.6 minutes (range, 45-90 minutes). Primary healing of incision was obtained in all cases; no injury of spinal cord and nerve root, cerebrospinal leakage, or deep infection occurred. The patients were followed up 6-23 months (mean, 14.5 months). No Cage subsidence and loosening, breaking, or pulling-out were observed. The symptoms and curvature of the cervical spine were obviously improved in all patients after operation. The VAS score, JOA score, NDI, and the cervical Cobb angle at 3 months and last follow-up showed significant differences when compared with preoperative ones (P lt; 0.05), but no significant difference was found between at 3 months and at last follow-up (P gt; 0.05). The interbody fusion was achieved in each operated segment of all patients according to Pitzen’s criteria. Conclusion The early effectiveness of ACDF with Zero-P system is satisfactory in treatment of cervical disc protrusion because it has the advantages of short operation time, less bleeding, good stability and restoration of the cervical alignment.
ObjectiveTo evaluate the effectiveness of cervical disc replacement for cervical myelopathy. MethodsBetween October 2006 and October 2008, 20 patients (26 segments) with cervical myelopathy underwent single-level (14 segments) or bi-level (6 segments) cervical disc replacement. There were 8 males and 12 females with an average age of 46 years (range, 26-65 years). The disease duration ranged 2-18 months (mean, 7 months). The effectiveness was evaluated using visual analogue scale (VAS) score, cervical range of motion (ROM), and the Odom et al. criteria. Heterotopic ossification (HO), osteophyte formation, and prosthesis loosening were observed. ResultsAll incisions healed by first intention, with no severe complication. Twenty patients were followed up 30-48 months (mean, 34 months). At 28 months after operation, according to Odom et al. criteria, the results were excellent in 17 cases and good in 3 cases. The VAS scores of the neck, shoulder, and upper limb were significantly improved when compared with preoperative scores (P lt; 0.05). At 30 months after operation, X-ray films showed that 20 replaced segments were mobile and ROM was (10.6 ± 4.5)°, showing no significant difference (P gt; 0.05) when compared with that of upper adjacent segment (10.8 ± 3.7)° and lower adjacent segment (7.5 ± 4.2)°. HO occurred in 10 cases (13 segments). No displacement, subsidence, or loosening occurred except 1 case of retrodisplacement of the prosthesis. ConclusionCervical disc replacement can obtain good effectiveness. It can maintain normal cervical ROM and physiological curvature. But it needs further long-term follow-up to evaluate the function and the influence on the adjacent segments.
Objective To study the cl inical appl ication of Mobi-C prosthesis in treatment of anterior cervical discectomy and artificial disc replacement (ADR). Methods Between January 2009 and June 2009, 20 cases of degenerative cervical disease were treated with anterior discectomy and ADR by Mobi-C prosthesis, including 13 cases of cervical disc herniation and 7 cases of cervical spondylotic radiculopathy, and 25 Mobi-C prosthesis were implanted. There were 8 males and 12 females, aged 29-54 years (mean, 45.2 years). The disease duration was from 4 days to 5 years (mean, 1.2 years). Affected segments of process included C3, 4 in 1 case, C4, 5 in 2 cases, C5, 6 in 7 cases, C6, 7 in 5 cases, C4, 5 and C5, 6 in 2 cases, and C5, 6 and C6, 7 in 3 cases. Radiographs were taken regularly, and cervical range of motion (ROM) on segments of disc replacements were measured. The functions of cervical spinal cord were evaluated by “40 score” system (COA) preoperatively, immediately postoperatively, and at follow-up. The qual ity of l ife was evaluated by neck disabil ity index (NDI) and visual analogue scale (VAS) score. Results All incisions healed by first intention. No perioperative compl ication was found. All cases were followed up 16.5 months on average (range, 14-18 months). There was no significant difference in cervical ROM of operatied segment between preoperation and follow-up duration (t=0.808，P=0.440). No heterotopic ossification was found at follow-up. COA score at last follow-up (38.20 ± 1.14) was significantly higher than preoperative one (32.10 ± 2.96) , (t=9.278，P=0.000) , and the improvement rate at last follow-up was 77.2% ± 5.4%. VAS score at last follow-up (3.20 ± 1.23) had significant difference when compared with preoperative one (5.10 ± 1.29), (t=10.585，P=0.000). NDI score at last follow-up (29.40 ± 4.55) had significant difference when compared with preoperative one (39.20 ± 3.80), (t=16.039, P=0.000). Conclusion A satisfactory short-term curative effect can be obtained by using Mobi-C prosthesis in treatment of anterior cervical discectomy and ADR.
To evaluate the effectiveness of interrupt percutaneous endoscopy lumbar discectomy (PELD) through interlaminar approach for L5, S1 disc protrusion. Methods Between November 2006 and August 2010, 115 patients with L5, S1 disc protrusion were treated, including 79 males and 36 females with an average age of 38 years (range, 14-79 years). All patients showed the dominated symptom of the S1 nerve root. The working channel was establ ished by puncturing through interlaminar approach under the local anesthesia. After the needle was used to make sure no nerve root or dural sac on working face, the disc tissue was excised directly by bl ind sight. Then the nerve root decompression was observed through the endoscope. In patients with free type, fragment compression was observed through the endoscope, and the disc tissue around the nerve roots was removed, then the free disc tissue around intervertebral space was excised. Results One patient who failed to puncture changed to miniopen discectomy; 3 patients who failed changed to post lateral approach; and the others underwent interrupt PELD through interlaminar approach. Eighty patients were followed up 18 months on average (range, 12-36 months). The average Oswestry Disabil ity Index (ODI) was reduced to 13% ± 5% at 12 months after operation and to 12% ± 8% at last follow- up from 73% ± 12% at preoperation, showing significant differences (P lt; 0.01). According to modified Macnab ,s criterion, the results were excellent in 59 cases, good in 15 cases, fair in 3 cases, and poor in 3 cases at last follow-up, and the excellent and good rate was 92.5%. Conclusion For the treatment of disc protrusion at the L5, S1 level, interrupt PELD through interlaminar approach should be ideal with short operation time, small trauma, and quick recovery.
Objective To invest igate the ef fect iveness and signi f icance of percutaneous endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer for degenerative lumbosacral disc disease. Methods Between January 2007 and August 2008, 21 patients with degenerative lumbosacral disc disease were treated with endoscopic discectomy followed by interbody fusion using B-Twin expandable spinal spacer. Among them, there were 13 males and 8 females with an average age of 52 years (range, 28-79 years). And the disease duration ranged from 3 months to 40 years (median, 9 months). The affected segments included T11, 12, T12-L1, L1, 2, and L2, 3 in 1 case respectively, L4, 5 in 4 cases, and L5, S1 in 13 cases. All patients had intractable low back pain or lower extremity radicular symptoms. The placement methods of B-Twin expandable spinal spacer were double sides in 15 cases and single side in 6 cases. Oswestry Disabil ity Index (ODI) and Macnab grading were used to determine the function recovery after operation. And Suk’s standard was used to determine the fusion effects by X-ray. Results All 21 patients were followed up 18 months to 3 years (mean, 23.8 months). Sciatica symptoms disappeared after operation in 19 cases, no significant improvement occurred in 2 cases of thoracic disease. The ODI scores were 79% ± 16% at preoperation, 30% ± 9% at 1 month, 26% ± 10% at 3 months, 21% ± 12% at 6 months, and 20% ± 10% at 18 months after operation, showing significant differences between pre- and postoperation (P lt; 0.05). According to Macnab grading at 6 months postoperatively, the results were excellent in 14 cases, good in 5 cases, and fair in 2 cases with an excellent and good rate of 90.5%. According to Suk et al. standard, the results were excellent in 1 case, good in 19 cases, and poor in 1 case with an excellent and good rate of 95.2%. The muscle strength of the lower extremities had no improvement in 1 case of T11, 12 disc protrusion; pedicle screws fixation and decompression laminectomy were given after 6 months, but no improvement was achieved during follow-up. Protrusion recurred after 4 months in 1 case of L4, 5 disc protrusion, then was cured by laminectomy discectomy. The remaining patients achieved postoperative rel ief. Conclusion Endoscope combined with interbody fusion is a good combination to solve lumbar instabil ity. B-Twin expandable spinal spacer is a minimally invasive fusion choice of L4, 5 and L5, S1.