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Background: Percutaneous transforaminal endoscopic discectomy (PTED) has become the standard surgery for the patients of lumbar disc herniation with the advantages of less trauma and rapid recovery. But still some patients have poor prognosis after PTED. A major risk factor associated with the poor prognosis may be the unfit function exercise. Objective: To discuss the effect of overall functional exercise process for PTED. Methods: In January 2019 to June 2020, a single center randomized controlled trial was proceeded. The patients scheduled for PTED were randomly divided into the experimental group, which received overall functional exercise and the control group, which received routine process. The overall process included advance, whole-course exercise and integrating of traditional Chinese medical methods. The general information, visual analog scale (VAS) score and Oswestry Dysfunction Index (ODI) score at each follow-up point perioperative period were compared between the 2 groups. Results: There were no significant differences in the general information, the preoperative VAS and ODI. On the 3rd day after operation, the VAS of low back pain and leg pain in the experimental group were lower than the control group. One month after operation, the VAS of low back pain in the experimental group was lower than that in the control group. One to 3 months after operation, the ODI scores of the experimental group were better than that of the control group. There was no significant difference in modified MacNab index between the experimental group and the control group. Conclusion: Function exercise is important for the prognosis of minimally invasive lumbar surgery. The overall function exercise process perioperative is helpful to relieve the short-term pain of the patients and significantly improve the prognosis.

This study aimed to analyze the most influential publications on vertebral augmentation for treating osteoporotic vertebral compression fracture. The Web of Science database was searched using the key words "percutaneous vertebroplasty," "percutaneous kyphoplasty," "balloon kyphoplasty," "vertebroplasty," "kyphoplasty," and "vertebral augmentation." The top 100 publications were arranged by citations per year and descriptively and visually analyzed. The top 100 publications were cited 25,482 times, with an average of 14.4 citations per paper per year. The corresponding authors of the publications represented 17 nations, with most authors being American (46 authors). Thirty-two journals were involved, with SPINE issuing the most publications (24 papers of the 100). Clinical research (73 of the 100 papers) outnumbered basic studies (14 papers) and systematic reviews (13 papers), and the most publications were published between 2000 and 2004. Co-citation analysis of the key words indicated that the top 5 focus areas were "complication," "balloon kyphoplasty," "vertebral compression fracture," "biomechanics," and "calcium phosphate cement." The top 3 keywords with the strongest citation bursts were "compression fracture," "cement," and "balloon kyphoplasty." The keywords with persistent strong citation bursts are "balloon kyphoplasty" and "augmentation." There are still contrary opinions about vertebral augmentation; new research should be conducted with more deliberate design and longer follow-up.

Introduction: Postoperative discal pseudocyst (PDP) is rare. Few studies have reported on the recurrence of PDPs, and there is a lack of understanding of their clinical features and treatment methods. This study discusses the clinical characteristics and treatment of recurrent PDPs. Patient concerns: A 25-year-old man presented with radiating pain and numbness in the lateral left calf and dorsum of the foot. Diagnosis: Postoperative discal pseudocyst. Interventions: He underwent lumbar discectomy, which provided immediate postoperative relief. However, the symptoms recurred 45 days later. Magnetic resonance imaging (MRI) showed a lesion compressing the dura and nerve roots at the site of the previous surgery. The lesion appeared hypointense on T1-weighted imaging and hyperintense on T2-weighted imaging. The patient was treated conservatively for 1 month without significant relief. He then underwent lumbar discectomy and cyst removal, which immediately relieved his symptoms. However, 27 days later, the patient again developed the same symptoms. MRI examination showed recurrence of PDP. As 1 month of conservative treatment failed to relieve the patient’s symptoms, we performed posterior instrumented lumbar fusion and cyst removal. Outcomes: The patient’s symptoms disappeared, and have not recurred for 1 year at the time of writing. Conclusions: PDP is a rare complication of lumbar discectomy. Repeat lumbar discectomy can effectively treat PDP, but the cyst can recur. We, for the first time, used posterior instrumented lumbar fusion to successfully treat recurrent PDP.

Background Pulmonary arterial hypertension (PAH) is the commonest complication of left-to-right shunt congenital heart disease (CHD). Detection of pulmonary vascular reactivity is important for the evaluation of patient with PAH. ObjectiveThis study aimed to investigate the acute hemodynamic responses to iloprost in patients with idiopathic PAH (IPAH) and PAH associated with systemic-to–pulmonary shunt CHD (PAH-CHD). Methods This study included a cohort of patients with IPAH and PAH-CHD. The inclusion criteria were: ➀ IPAH with pulmonary artery systolic pressure > 70mmHg measured by catheter and ➁ PAH-CHD with pulmonary artery systolic pressure > 70mmHg and pulmonary-to-systemic flow ratio (Qp/Qs) <1.5. After determination of baseline haemodynamic parameters by cardiac catheterization, 10μg of aerosol iloprost was inhaled and right heart catheterization was repeated. Results A total of 165 patients (118 females) aged 29 ± 13 years were recruited, including 24 with IPAH and 141 with PAH-CHD. There were 2 acute positive responders (8.3%) in patients with IPAH who benefited from the treatment of calcium antagonist thereafter. No positive responder was found in patients with PAH-CHD. Inhalation of aerosol iloprost induced significant decrease in pulmonary artery pressure (P > 0.01), pulmonary vascular resistance (P < 0.01) and pulmonary-to-systemic vascular resistance ratio (P < 0.05) in patients with both IPAH and PAH-CHD. However, significant increase in oxygen saturation of femoral blood was only observed in patient with PAH-CHD. A ≥10% decrease in both pulmonary vascular resistance and pulmonary-to-systemic vascular resistance ratio at the end of drug exposure was observed in 58.9% of patients with PAH-CHD had but only in 45.8% of patients with IPAH. Conclusions There are 8.3% of acute positive responders in patients with IPAH but no positive response in patients with PAH-CHD. Although iloprost induces decrease in pulmonary artery pressure and pulmonary vascular resistance in patients with patients with IPAH and PAH-CHD, the acute hemodanamic changes were different.