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Objectives: This study compared the risk of symptomatic recurrent disc herniation and clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) versus open lumbar microdiscectomy (OLM) for lumbar disc herniation with 2 years of follow-up. Materials and Methods: We analyzed 23 patients who underwent PELD and 32 patients who underwent OLM for lumbar disc herniation. The numeric rating scale of back and leg pain, Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ) were assessed before and at 12 and 24 months after the surgery. The wound pain and complications were also recorded. Survival analysis was performed to estimate the risk of symptomatic recurrent disc herniation. Results: In the comparison of groups, the reductions in back and leg pain, ODI, and RMDQ were not significantly different at 12 and 24 months. For patients who underwent PELD, the wound pain was significant lower at the day of surgery. The survival rate of patients who were free from symptomatic recurrent disc herniation at 24 months was 0.913 in PELD and 0.875 in OLM, and the log-rank test revealed no significant difference between the two survival curves. The incidence of complication was not significantly different between groups. Conclusion: Both PELD and OLM are effective treatments for lumbar disc herniation because they have similar clinical outcomes. PELD provided patients with less painful wounds. The survival analysis revealed that the risk of symptomatic recurrent disc herniation in 2 years of follow-up was not different between PELD and OLM.

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Ipsilateral femoral neck fracture after hardware removal in healed trochanteric fracture is a rare complication. We reported a case of a 79-year-old woman who had undergone open reduction and internal fixation for her left intertrochanteric fracture with a long Gamma nail about 1 year ago. She asked for implants removal due to local irritation. However, 5 days after implants removal, left subcapital femoral neck fracture occurred. Removal of implants under elective indications could lead to high complication rate. Orthopedic surgeons should perform the removal of hardware in healed intertrochanteric fracture for very selected cases.

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OBJECTIVE: Conventional laminectomy for spine decompression involves inherent complications resulting from perioperative traumatization of posterior structures. Minimally invasive decompression was developed to address these issues. Full endoscopic spine surgery has shifted the paradigm from disc pathology to spinal stenosis by overcoming the limitation of bony procedures with evolving endoscopic instruments. However, a steep learning curve restricts the development of endoscopic decompression. The purpose of this study is to describe full endoscopic uniportal unilateral laminotomy for bilateral decompression through the interlaminar approach and to evaluate its efficacy and safety in 2 years of follow-up. METHODS: A total of 106 patients (45 men, 61 women) with degeneration lumbar stenosis involving 165 segments were enrolled from April 2015 to June 2017, and treated by full endoscopic uniportal unilateral laminotomy for bilateral decompression. We made an 8-mm incision and used a general-size endoscope (working channel 4.3 mm) to avoid neurological compromise during the demonstration. RESULTS: The visual analogue scale (VAS) results for back pain revealed a significant reduction from preoperative 6.8 ± 2.1 to 1.7 ± 1.7 after 2 years (P < 0.001). The VAS results for leg pain revealed a significant reduction from preoperative 7.6 ± 1.3 to 1.3 ± 1.6 after 2 years (P < 0.001). The Oswestry Disability Index showed significant improvement from preoperative 62.0 ± 13.9 to 14.6 ± 15.7 after 2 years (P < 0.001). The average operation time was 68.9 ± 10.0 minutes per level. One case had iatrogenic durotomy, 1 case underwent revision surgery due to incomplete decompression, and 2 cases had delayed wound healing. CONCLUSIONS: This procedure obtained successful and satisfactory outcomes for patients, and was more feasible for surgeons.

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PURPOSE: The precise mechanism and pathological role of postlaminectomy/laminotomy fibrosis (PLF) in postoperative neurological deficits have not been established. Many studies use magnetic resonance imaging (MRI) to prove that there is no consistent correlation between PLF and postoperative neurological deficits and back pain (PNDBP). Therefore, we assumed that the direct-compression effect may not be the only factor but that other neurological deficits associated with pathological mechanisms should exist and need more investigation. The purpose of this study was to compare over time the differences and changes in histopathological properties of PLF in rats. METHODS: We used a rat model with walking-track analysis for neurologic evaluation, grading scale to evaluate PLF, histomorphometric measurements of dura sac diameter, and histological tissue reactions (dura mater and spinal rootlets) juxtaposed to the postlaminectomy/laminotomy defect. The 54 adult Sprague-Dawley rats were divided into laminotomy (n = 18), laminectomy (n = 18), and sham-operation groups (n = 18). All groups were subdivided into three equal subgroups based on different postoperative time points (1, 2, and 3 months). All sections of vertebral column were stained with hematoxylin and eosin and with Masson's trichrome. RESULTS: The results showed that only a slight compression effect reflected by nonsignificant changes in the maximum anterior-posterior diameters within the dura sac, in the walking tract test, and increased grades of PLF over time. In addition, significant pathological inflammatory changes, such as thickening of the dura mater, axonal swelling, and neovascularization, were found in the post-laminectomy/laminotomy groups at each time point. CONCLUSION: Laminectomy-/laminotomy-related inflammation may lead to PLF, and these pathological changes may be the main cause of postoperative neurological deficits. These findings show that research on preventing PLF should include perioperative modulation of inflammatory reactions induced by laminectomy/laminotomy.

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Vertebroplasty for osteoporotic thoracolumbar vertebral compression fractures usually results in complete and immediate cessation of pain symptoms. Occasionally the procedure does not relieve pain and further intervention is required. We herein report the case of a 62-year-old female with L2 and L3 vertebral compression fractures treated with vertebroplasty. Her symptoms did not improve and subsequent magnetic resonance imaging showed focal changes in the S1 and S2 vertebral bodies; bone scintigraphy showed the characteristic Honda sign of a sacral insufficiency fracture. Sacroplasty at S1 and S2 completely relieved the patient's back pain. If a vertebroplasty fails to relieve back pain immediately after the procedure as expected, surgeons should be aware of the possibility of a concomitant sacral insufficiency fracture.

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