European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The objective of the study was to demonstrate the clinical characteristics of dural tears during percutaneous endoscopic lumbar discectomy (PELD) and to discuss how to prevent this unintended complication. The study used data from 816 consecutive patients who underwent PELD between 2003 and 2007. A total of nine patients (1.1%) experienced symptomatic dural tears. ⋯ As application of the endoscopic procedure has been broadened to more complex cases, the risk of dural tears may increase. Unrecognized dural tear with nerve root herniation may cause permanent neurological sequelae. Accurate information and proper technical considerations are essential to prevent this unpredictable complication.
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Facet tropism has been investigated as a predisposing factor for degenerative changes in the lumbar spine; however, no prior study has evaluated the relationship between disc bulge and facet tropism. In this study, we used kinetic magnetic resonance imaging (kMRI) to investigate the association between degree of facet tropism and amount of disc bulge in the lumbar spine in relation to age. kMRIs in the flexion, neutral, and extension positions were performed on 410 consecutive patients with low back pain. T2-weighted midsagittal and axial mid-disc cuts were analyzed to measure disc bulge and facet angle. ⋯ Maximal static bulge (MSB), maximal dynamic bulge (MDB), and age in the facet tropism groups were compared by age subpopulations and MDB categories, defined by the positions between which the largest change in disc bulge occurs. We found the severe facet tropism group to be associated with a nearly significant increase in MSB and MDB over the no facet tropism group in the older subpopulation at the L4-L5 level only, and a larger MDB in the L4-L5 MDB category [E-N], where the greatest change in disc bulge occurs between neutral and extension positions (p = 0.013). Our findings suggest that severe facet tropism is associated with increased disc bulge at L4-L5 in only a subset of older age patients, but may in large part be due to biomechanical factors that define the [E-N] category.