Pain physician
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Comparative Study
Comparison of 3 Anesthetic Methods for Percutaneous Transforaminal Endoscopic Discectomy: A Prospective Study.
Percutaneous transforaminal endoscopic discectomy (PTED) under local anesthesia (LA) is growing popular in recent years because of its safety, effectiveness and increased patient demands for minimally invasive procedures. To avoid neural injuries, local anesthesia that can keep the patient conscious is recommended. However, many patients complain about the severe pain during surgery. Epidural anesthesia (EA) is an alternative choice. We put forward an anesthetic method that combined preemptive analgesia (PA) and local anesthesia. ⋯ Percutaneous transforaminal endoscopic discectomy (PTED), local anesthesia, epidural anesthesia, preemptive analgesia, morphine, ropivacaine, pain management, visual analog scale (VAS), Oswestry Back Pain Disability Index (ODI).
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Residual disc fragments are observed on immediate postoperative magnetic resonance imaging (MRI) in 2.8-15% of patients after percutaneous endoscopic lumbar discectomy (PELD). Considering the known postoperative longitudinal outcomes in patients with residual disc tissue, a 'watchful waiting' strategy may be preferable to immediate re-operation in patients with asymptomatic residual disc material. ⋯ Discectomy, endoscopes, longitudinal studies, patient-reported outcome, percutaneous, reoperation, spine, residual disc.
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Glucocorticoids adversely affect bone mineral density (BMD) and increase the risk of fracture. Yet, the cause-and-effect relationship between epidural steroid injection (ESI) and BMD has not been thoroughly investigated, and available results are inconsistent. This is probably a consequence of differences in the dose of steroids and follow-up duration. ⋯ Epidural steroid injection, bone mineral density, osteoporosis, postmenopausal women, glucocorticoids, bone turnover markers, osteoporotic fracture.
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Percutaneous endoscopic lumbar discectomy (PELD) has become an increasingly popular minimally invasive spinal surgery. Due to the technical evolution of PELD, the focus of decompression has shifted from the central nucleus to the subannular-protruded disc herniation, which allows direct neural decompression. Surgical entry into the spinal canal leads to the greater possibility of bony structure obstruction, thus the location and direction of the working channel are crucial. The existing preoperative measuring methods mainly rely on 2-dimensional (2D) x-ray images or MRI cross-sections. Because the bony structure and the trajectory are 3-dimensional (3D), the relationship between the anatomical lumbar structure and the working channel cannot be precisely evaluated. ⋯ Lumbar disc herniation, percutaneous endoscopic lumbar discectomy (PELD), transforaminal, trajectory, 3D method, quantitative measurement, angulation, bony structure obstruction.
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Numerous techniques have been developed for the treatment of disc herniation. Oxygen-ozone (O2-O3) mixture therapy is a minimally invasive percutaneous treatment for disc herniation. ⋯ Cervical disc herniation, chemonucleolysis, injection, intradiscal, oxygen-ozone mixture, percutaneous treatment.