Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion under intraoperative neuromonitoring

Abstract

Introduction: Traditional open discectomy and intervertebral fusion surgery is the common strategy for lumbar disc herniation (LDH). However, it has the disadvantages of long recovery time and severe paravertebral soft tissue injury. Zina percutaneous screw fixation combined with endoscopic lumbar intervertebral fusion (ZELIF), as a novel minimally invasive surgical technique for LDH, has the advantages in quicker recovery, less soft tissue destruction, shorter hospital stays and less pain. We report a novel technique of ZELIF under intraoperative neuromonitoring (INM) for the treatment of LDH. Patient concerns: A 51-year-old male presented to our hospital with left lower extremity pain and numbness for 1 year. Diagnosis: Lumbar disc herniation (LDH). Interventions: This patient was treated with Zina percutaneous screw fixation combined with endoscopic neural decompression, endplate preparation, and intervertebral fusion through Kambin's triangle. Each step of the operation was performed under INM. Outcomes: The follow-up period lasted 12 months; the hospitalization lasted 4 nights; the blood loss volume was 65 ml, and the time of operation was 266 min. INM showed no neurological damage during the surgery. No surgical complications, including neurological deterioration, cage migration, non-union, instrumentation failure or revision operation, were observed during the follow-up period. Visual Analogue Scale (VAS) score reduced from 7 to 1; the Oswestry Disability Index (ODI) decreased from 43 to 14; the EQ-5D score was 10 preoperatively and 15 at the final follow-up visit; the Physical Component Summary of the 36-Item Short Form Health Survey (SF-36) was 48 preoperatively and 49 at the last follow up visit; the SF-36 Mental Component Summary was 47 before surgery and decreased to 41 postoperatively. Conclusion: ZELIF under INM may represent a feasible, safe and effective alternative to endoscopic intervertebral fusion and percutaneous screw fixation, for decompressing the lumbar's exiting nerve root directly with minimal invasion in selected patients.

A retrospective comparative study of local anesthesia only and local anesthesia with sedation for percutaneous endoscopic lumbar discectomy

“…However, local anesthesia may be superior to general anesthesia in information feedback. According to previous studies, simultaneous intraoperative feedback and good surgical experience remain challenging in LDH patients who underwent percutaneous endoscopic lumbar discectomy 23 . We, herein, applied local anesthesia combined with conscious sedation to improve the surgical experience for LDH patinets in percutaneous endoscopic lumbar discectomy.…”

A Retrospective Comparative Study of Local Anesthesia Only and Local Anesthesia with Sedation for Percutaneous Endoscopic Lumbar Discectomy

“…However, local anesthesia may be superior to general anesthesia in information feedback. According to previous studies, simultaneous intraoperative feedback and good surgical experience remain challenging in LDH patients who underwent PELD 22 . We hypothesized that using dexmedetomidine and oxycodone hydrochloride under local anesthetics in PELD could achieve a good analgesic effect and improve the surgical experience for LDH patients.…”

Application of Intraoperative Electromyography Intelligent Monitoring in Orthopedic Surgery under General Anesthesia

“…Back pain and symptoms of nerve root compression, including pain, numbness, and weakness, are common causes of disability and reduced overall quality of life. In most cases, initial conservative treatment, including rest, core muscle strengthening, and nonsteroidal anti-inflammatory drugs, helps with recovery [ 2 ]. However, surgical intervention is sometimes required to decompress nerve roots and restore spinal stability, posterior laminectomy, and discectomy can be used for isolated nerve root compression.…”