Objective To comparatively analyze the efficacy differences between unilateral open-door laminoplasty and combined foraminoplasty in treating mixed (myelopathic and radiculopathic) cervical spondylopathy. Methods Patients with mixed (myelopathic and radiculopathic) cervical spondylopathy who underwent the two surgical procedures at the Third People’s Hospital of Chengdu between January 2017 and December 2023 were retrospectively selected. According to the surgical method, patients were divided into the open-door surgery group and the combined surgery group. The basic information, surgical related indicators, clinical efficacy scores, and complications between the two groups were compared. Results A total of 65 patients were included. Among them, there were 38 males and 27 females; 30 cases in the open-door surgery group and 35 cases in the combined surgery group; The average follow-up period was (18.6±6.8) months. There were no statistically significant differences in age, gender, surgical stage, and disease duration among the groups (P>0.05). Except for the operation time (P<0.05), there was no statistically significant difference in incision length and intraoperative bleeding between the two groups (P>0.05). There was no statistically significant difference in preoperative Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups (P>0.05). The difference in Visual Analogue Scale and Japanese Orthopaedic Association Score between the two groups six months after surgery was statistically significant (P<0.05). No severe complications such as surgical failure, uncontrollable hemorrhage, or intraoperative nerve/spinal cord injury occurred. No significant cervical instability occurred in either group. Conclusions For treating mixed (myelopathic and radiculopathic) cervical spondylopathy, unilateral open-door laminoplasty combined foraminoplasty may reduce the incidence of nerve root palsy and yield superior clinical outcomes compared to laminoplasty alone. This combined approach does not increase surgical risk and may potentially avoid the need for revision anterior cervical surgery.
Objective To discuss the effectiveness and the safety of accurate decompression via foraminoplasty in treating lumbar lateral recess stenosis patients who accompanied by disk-flavum ligamentum space and bony lateral recess stenosis, and to analysis the short-term effectiveness of the surgical procedures. Methods Forty-five lumbar lateral recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis were treated by accurate decompression via foraminoplasty between January 2013 and January 2016. There were 29 males and 16 females with a median age of 58 years (range, 42-82 years). The disease duration was 3-96 months (mean, 24.4 months). The lesion segment included L4, 5 in 36 cases and L5, S1 in 9 cases. The visual analogue scale (VAS) score of low back pain and leg pain at preoperation and last follow-up were recorded, and the modified Macnab criteria was used to evaluate the effectiveness at last follow-up. Postoperative CT and MRI were reviewed to evaluate the stability and decompression of the lumbar spine. Results All operations were successfully completed. All the 45 patients were followed up 3-18 months (median, 11 months). Dural tear occurred in 2 cases during operation, bone graft removed into the spinal canal in 1 case, postoperative low back pain occurred in 5 cases, and there was no nerve root injury, hematoma formation, or other complications. The leg pain VAS score at last follow-up (0.6±1.2) was significantly improved when compared with preoperative score (5.7±1.4) (t=8.981, P=0.001); and the low back pain VAS scores showed no significant difference between preoperation and last follow-up (1.5±1.3vs. 1.7±1.4;t=0.535, P=0.585). According to the modified Macnab criteria, the results were excellent in 20 cases, good in 22 cases, fair in 2 cases, and poor in 1 case at last follow-up, and the excellent and good rate was 93.3%. Conclusion Accurate decompression via foraminoplasty is an effective, safe, and less invasive way for treating lumbar recess stenosis patients accompanied by disk-flavum ligamentum space and bony lateral recess stenosis.
Objective To evaluate the effectiveness of visualized reamer foraminoplasty in transforaminal endoscopic lumbar discectomy (TELD) for the treatment of lumbar disc herniation (LDH). Methods A retrospective analysis was conducted on the clinical data of 100 LDH patients who met the selection criteria and underwent TELD between January 2022 and June 2024. According to the foraminoplasty technique, patients were divided into a visualized group and a transforaminal endoscopic spine system (TESSYS) group, with 50 patients in each group. There were no significant differences in baseline data between the two groups (P>0.05), including gender, age, surgical level, disease duration, preoperative visual analogue scale (VAS) scores for low back and lower limb pain, and Oswestry disability index (ODI). The intraoperative fluoroscopy frequency, operation time, intraoperative blood loss, hospital stay, time from operation to discharge, and complications were recorded and compared between the two groups. Low back and lower limb pain were assessed using VAS scores, and function status was evaluated using ODI preoperatively and at 1 day, 1, 3, 6, and 12 months postoperatively. Surgical outcomes were evaluated at last follow-up using the modified MacNab criteria. Results All surgeries were completed successfully, with primary healing of the incisions. The visualized group showed significantly shorter operation time and fewer fluoroscopy frequencies than the TESSYS group (P<0.05). No significant differences were found between the two groups in intraoperative blood loss, time from operation to discharge, or hospital stay (P>0.05). One case of recurrence occurred in the visualized group, compared to 3 cases in the TESSYS group, with no significant difference between the groups (P>0.05). Postoperative lower limb dysesthesia occurred in 4 cases in the TESSYS group, but was not observed in the visualized group, showing a significant difference (P<0.05). No other complications, such as vascular injury, cerebrospinal fluid leakage, incisional hematoma, or infection occurred in either group. Both groups showed significant improvement in low back VAS score, lower limb VAS score, and ODI at all postoperative time points compared to preoperative values (P<0.05). No significant difference was found in low back VAS score, lower limb VAS score, or ODI between the two groups at any postoperative time point (P>0.05). According to the modified MacNab criteria at last follow-up, the excellent-good rates were 96% and 92% in the visualized and TESSYS groups, respectively, with no significant difference (P>0.05). Conclusion Both TESSYS and visualized reamer foraminoplasty techniques yield satisfactory outcomes in the treatment of LDH via TELD. The latter can significantly reduce intraoperative fluoroscopy frequency and operation time, but the effectiveness of the two groups is comparable.