Purpose Lumbar spinal stenosis (LSS) with instability is most common lumbar degenerative diseases for people with low back pain. The objective of this study was to compared the clinical effects for the treatment of lumbar spinal stenosis (LSS) with degenerative instability between the innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) technique and posterior lumbar interbody fusion (PLIF) technique. Patients and Methods Between April 2019 and April 2020, 114 patients with single-segment LSS were prospectively included in our study (ChiCTR1900022492). Visual Analogue Scale (VAS) on lumbar and leg pain (VAS-LBP, VAS-LP), Oswestry Disability Index (ODI), serum creatine kinase (CK), the maximal cross-sectional area of multifidus muscle (Max-CSA) and the peak intensity of sulphur hexafluoride microbubble contrast agent (PI) around the surgical incision by contrast-enhanced ultrasonography were evaluated preoperatively, post-operatively and at regular follow-up. Results All patients were followed up. The VAS-LBP, VAS-LP, ODI after operation were improved significantly compared to these data before operation in all the patients (P<0.05). The VAS-LBP at 1 weeks, 3 months after operation in PE-TLIF group were significantly lower than these in PLIF group (P<0.05). The injury degree of multifidus muscle evaluated by MAX-CSA and PI was significantly less in PE-TLIF group after operation (P<0.05). There was no significant difference on the complication rate between these two groups (P>0.05). Conclusion Our results presented PE-TLIF technique could obtain comparable effective outcomes as conventional PLIF for the treatment of LSS with degenerative instability. The patients with PE-TLIF had less muscle injury, less pain and quicker postoperative rehabilitation.

Background Compared to PLIF, the advantages of PE-TLIF are its greater preservation of the posterior components of the lumbar spine and its reduction of damage to the paraspinal muscles. However, the full extent of postoperative paraspinal muscle changes after damage by PE-TLIF has remained largely unknown. This is the first study to compare the changes in paraspinal muscles between PLIF and PE-TLIF directly using CT and clinical effects. Methods This study included 52 patients with lumbar spinal stenosis who were treated at Beijing Chaoyang Hospital between January, 2020 and January, 2021. Among them, 22 patients received PLIF, and 30 received PE-TLIF. Outcome metrics including the ODI, VAS-LBP, and VAS-LP at pre-surgery and 1-week, 6-months, and 12-months post-surgery were used to evaluate the clinical effects of both procedures. Additionally, radiographic metrics including the MF FCSA, FI rate, and muscle density were used to evaluate changes in patients’ MF muscles. Results The PE-TLIF group has better performance on the VAS-back pain scale at the 1-day follow-up (PE-TLIF: 3.25 vs. PLIF: 4.32, P = 0.003) and 1-week follow-up (PE-TLIF: 2.53 vs. PLIF: 3.61, P༜0.001). At 6 months after surgery, there was no statistical difference in MF FCAS, FI rate, or CT density between the PLIF and PE-TLIF groups. There was also no statistically significant atrophy of the MF FCSA in both groups at the last (12-month) follow-up (PE-TLIF: 506.5 (488.0,535.0) mm2; PLIF: 512.0 (485.3,564.5) mm2, P༞0.05). At the 12-month follow-up, the FI rate in the MF muscles in the PLIF group was higher than that in the PE-TLIF group (PE-TLIF: 3.0 (2.8,3.0); PLIF:3.0 (3.0,4.0), P༜0.05), and the same result was also observed in CT density (PE-TLIF: 34.2 (31.8,36.9) Hu; PLIF: 30.5 (28.5,32.1) Hu, P < 0.05). Conclusion PE-TLIF can achieve satisfactory clinical results. After 12 months post-surgery, we observed no excess MF atrophy in the PE-TLIF group compared to the PLIF group, and the FI rate and muscle density of the MF in the PE-TLIF group were better than those in the PLIF group.

Background. The objective of this study was to investigate the enhanced recovery clinical effects of an innovative percutaneous endoscopic transforaminal lumbar interbody fusion (PE-TLIF) for the treatment of patients with LSS and degenerative instability. Methods. From January 2019 to March 2020, 51 patients with single-segment LSS and degenerative instability were prospectively included in our study (ChiCTR1900020679). The Oswestry Disability Index (ODI), the visual analogue scale (VAS) on lumbar and leg pain (VAS-LBP and VAS-LP), serum creatine kinase (CK), the peak intensity of sulphur hexafluoride microbubble contrast agent (PI), and the maximal cross-sectional area of multifidus muscle (Max-CSA) around the surgical incision were assessed preoperatively, postoperatively, and at regular follow-up. Results. All patients were followed up. The mean postoperative bedridden time was 20.45 ± 2.66 hours. The ODI, VAS-LBP, and VAS-LP were improved significantly after operation compared to these data before operation in all the patients ( P < 0.05 ). The CK at 1 day after operation was higher compared to the data before the operation ( P < 0.05 ), and there was no significant difference on CK at 1 week after operation ( P > 0.05 ). The PI at 1 week after operation was higher compared to this item before operation ( P < 0.05 ), and there was no significant difference on PI at 1 month or 3 months after operation ( P > 0.05 ). The Max-CSA at 1 week after operation was higher compared to this item before the operation ( P < 0.05 ), and there was no significant difference in Max-CSA at 1 month or 3 months after operation compared with before the operation ( P > 0.05 ). Conclusions. Our results and systematic review presented the innovative PE-TLIF technique could obtain satisfactory and effective outcomes for the treatment of patients with LSS and degenerative instability. Our PE-TLIF technique also had the ability to decrease the MF injury and obtain an enhanced recovery.

BackgroundGorham–Stout syndrome is an uncommon condition with a varied clinical presentation and unclear cause that is characterised by a proliferation of lymphatic capillaries and severe regional osteolysis. Spinal and visceral involvement increases the syndrome's morbidity and mortality rates. Here, we report about a male patient with Gorham's disease who developed local kyphosis and neurological disorders due to massive osteolysis.Case presentationA 13-year-old male patient presented with progressive kyphosis and massive osteolysis of the thoracic vertebrae. Halo-pelvic traction and vertebral column resection osteotomy were performed to reconstruct the spine and prevent disease progression. The entire lesion was resected, and an artificial vertebra filled with allograft bone was used to achieve temporary stability. Although the patient presented with chylothorax following surgery, which required thoracic drainage, the patient did achieve a satisfying outcome.ConclusionsLimited by the number of GSS cases with spinal involvement and chylothorax manifestations, halo-pelvic distraction as a preoperative preparation and vertebral column resection osteotomy provide a novel avenue for managing this disease.