Ranhee Kim1, Rae Hyung Kim1, Chi Heon Kim2, Yunhee Choi3, Hyun Sook Hong3, Sung Bae Park4, Seung Heon Yang5, Sung-Mi Kim6, Chun Kee Chung7. 1. Department of Medicine, Seoul National University College of Medicine. 2. Department of Neurosurgery, Seoul National University College of Medicine; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea. 3. Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea. 4. Department of Neurosurgery, Seoul National University College of Medicine; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea;Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Korea. 5. Department of Neurosurgery, Seoul National University College of Medicine; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea; 6. Department of Neurosurgery, Seoul National University College of Medicine. 7. Department of Neurosurgery, Seoul National University College of Medicine; Department of Neurosurgery, Seoul National University Hospital, Seoul, Korea; Clinical Research Institute, Seoul National University Hospital, Seoul, Korea; Medical Research Collaborating Center, Seoul National University College of Medicine, Seoul, Korea; Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea.
Abstract
BACKGROUND: Some patients with lumbar herniated intervertebral disc disease (HIVD) suffer from both pain and lateral shift or trunk list. In addition to pain, patients have concerns regarding whether trunk list is reversible. Surgical treatment is performed when pain is intractable to conservative management, but a reversal of trunk list is an incidental outcome. Percutaneous lumbar endoscopic discectomy (PELD) is one of the surgical treatment options for lumbar HIVD, but no results concerning its effect on trunk list have been reported. OBJECTIVES: The objectives of the present study were to determine the incidence of, and risk factors for, trunk list scoliosis or lateral shift and to report the outcomes of trunk list after PELD. STUDY DESIGN: Retrospective case study. IRB No. H 1111-025-384 SETTING; University medical Center, Seoul, Korea. METHODS: We selected 164 patients who were less than 60 years old, complained of unilateral leg pain, and underwent PELD. We measured the maximum trunk shift from the central sacral vertical line (CSVL-max) on preoperative whole spine radiographs and classified trunk list as CSVL-max ≥ 10 mm. CSVL-max was measured on serial radiographs taken at one, 3, 6, and 12 months postoperatively in patients with trunk list. RESULTS: Twenty-nine patients (17.9%) had trunk list (M:F=10:19; mean age, 37.1 ± 11.24 years). Female gender (OR 4.28; 95% CI, 1.49-12.3) and HIVD at L4-5 (OR 5.6; 95% CI, 1.8-16.7) were risk factors for trunk list. Trunk list was normalized (CSVL-max < 10 mm) in 15 (52%) patients after PELD, and the median time for normalization was 3-6 months. Prognostic factors for the recovery of trunk list were not identified. LIMITATIONS: Selection bias should be considered in interpreting these results. CONCLUSION: Trunk list, scoliosis or lateral shift, was observed in 18% of the patients at the time of surgery. Female gender and L4-5 disc herniation were risk factors for trunk list. Trunk list was reversible in more than 50% of patients within 6 months of PELD.
BACKGROUND: Some patients with lumbar herniated intervertebral disc disease (HIVD) suffer from both pain and lateral shift or trunk list. In addition to pain, patients have concerns regarding whether trunk list is reversible. Surgical treatment is performed when pain is intractable to conservative management, but a reversal of trunk list is an incidental outcome. Percutaneous lumbar endoscopic discectomy (PELD) is one of the surgical treatment options for lumbar HIVD, but no results concerning its effect on trunk list have been reported. OBJECTIVES: The objectives of the present study were to determine the incidence of, and risk factors for, trunk list scoliosis or lateral shift and to report the outcomes of trunk list after PELD. STUDY DESIGN: Retrospective case study. IRB No. H 1111-025-384 SETTING; University medical Center, Seoul, Korea. METHODS: We selected 164 patients who were less than 60 years old, complained of unilateral leg pain, and underwent PELD. We measured the maximum trunk shift from the central sacral vertical line (CSVL-max) on preoperative whole spine radiographs and classified trunk list as CSVL-max ≥ 10 mm. CSVL-max was measured on serial radiographs taken at one, 3, 6, and 12 months postoperatively in patients with trunk list. RESULTS: Twenty-nine patients (17.9%) had trunk list (M:F=10:19; mean age, 37.1 ± 11.24 years). Female gender (OR 4.28; 95% CI, 1.49-12.3) and HIVD at L4-5 (OR 5.6; 95% CI, 1.8-16.7) were risk factors for trunk list. Trunk list was normalized (CSVL-max < 10 mm) in 15 (52%) patients after PELD, and the median time for normalization was 3-6 months. Prognostic factors for the recovery of trunk list were not identified. LIMITATIONS: Selection bias should be considered in interpreting these results. CONCLUSION: Trunk list, scoliosis or lateral shift, was observed in 18% of the patients at the time of surgery. Female gender and L4-5 disc herniation were risk factors for trunk list. Trunk list was reversible in more than 50% of patients within 6 months of PELD.
Authors: Young Il Won; Woon Tak Yuh; Shin Won Kwon; Chi Heon Kim; Seung Heon Yang; Kyoung-Tae Kim; Chun Kee Chung Journal: Int J Spine Surg Date: 2021-12