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Li Z, Hou S, Shang W, Song K, Zhao H. New instrument for percutaneous posterolateral lumbar foraminoplasty: case series of 134 with instrument design, surgical technique and outcomes. Int J Clin Exp Med 2015; 8:14672-14679. [PMID: 26628949 PMCID: PMC4658838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 09/05/2015] [Indexed: 06/05/2023]
Abstract
Current solutions for treating uncontained lumbar disk herniation include laser assisted endoscopic foraminoplasty and Transforaminal Endoscopic Spine System, both of which have some issues in clinical practice. This study aims to report the design of a new instrument for percutaneous posterolateral foraminoplasty. 148 patients with uncontained lumbar disk herniation were treated with percutaneous foraminoplasty followed by transforaminal endoscopic discectomy. Follow up were obtained for 134 cases. The VAS scores of pre-operative and post-operative low back pain and sciatica were compared. Oswestry Disability Index (ODI) and MacNab scores were also obtained. Follow-up was up to 5 years postoperatively. There were 75 of excellent, 49 of good and 5 of fair according to MacNab score system, with total successful rate up to 92.5%. 5 cases with L5S1 disc herniation complained about irritation to the dorsal root ganglion. In conclusion, the new transforaminal endoscopic discectomy instrument is safe and effective for percutaneous foraminoplasty.
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Affiliation(s)
- Zhenzhou Li
- Department of Orthopedics, The First Affiliated Hospital of General Hospital of People's Libertion Army Beijing 100048, China
| | - Shuxun Hou
- Department of Orthopedics, The First Affiliated Hospital of General Hospital of People's Libertion Army Beijing 100048, China
| | - Weilin Shang
- Department of Orthopedics, The First Affiliated Hospital of General Hospital of People's Libertion Army Beijing 100048, China
| | - Keran Song
- Department of Orthopedics, The First Affiliated Hospital of General Hospital of People's Libertion Army Beijing 100048, China
| | - Hongliang Zhao
- Department of Orthopedics, The First Affiliated Hospital of General Hospital of People's Libertion Army Beijing 100048, China
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102
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Wang F, Shi R, Cai F, Wang YT, Wu XT. Stem Cell Approaches to Intervertebral Disc Regeneration: Obstacles from the Disc Microenvironment. Stem Cells Dev 2015; 24:2479-95. [PMID: 26228642 DOI: 10.1089/scd.2015.0158] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Intervertebral disc (IVD) degeneration results in segmental instability and irritates neural compressive symptoms, such as low back pain and motor deficiency. The transplanting of stem cell into degenerative discs has attracted increasing clinical attention, as a new and proven approach to alleviating disc degeneration and to relieving discogenic pains. Aside from supplementation with stem cells, the IVD itself already contains a pool of stem and progenitor cells. Since the resident disc stem cells are incapable of reversing the pathologic changes that occur during aging and disc degeneration, it has been debated as to whether transplanted stem cells are capable of providing an efficient and durable therapeutic effect, even though there have been positive outcomes in both animal models and in clinical trials. This review aims to decipher the interactions between the stem cell and the disc microenvironment. Within their new niches in the IVD, the exogenous stem cell shows metabolic adaptation to the low-glucose supply, hypoxia, and compressive loadings, but demonstrates little tolerance to the disc-like acidity and hypertonicity. Similarly, the survival of endogenous stem cells is threatened as well by the harsh disc microenvironment, which may exhaust the stem cell resources and restrict the self-repair capacity of a degenerating IVD. To eliminate the intrinsic obstacles within the stressful disc niches, stem cells should be delivered with an injectable scaffold that provides both survival and mechanical support. Quick healing or concretion of the injection injuries, which minimizes stem cell leakage and disturbance to disc homeostasis, is of equal importance toward achieving efficient stem cell-based disc regeneration.
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Affiliation(s)
- Feng Wang
- 1 Department of Spine Surgery, Zhongda Hospital, Southeast University , Nanjing, China .,2 Surgery Research Center, Medical School of Southeast University , Nanjing, China
| | - Rui Shi
- 1 Department of Spine Surgery, Zhongda Hospital, Southeast University , Nanjing, China .,2 Surgery Research Center, Medical School of Southeast University , Nanjing, China
| | - Feng Cai
- 1 Department of Spine Surgery, Zhongda Hospital, Southeast University , Nanjing, China .,2 Surgery Research Center, Medical School of Southeast University , Nanjing, China
| | - Yun-Tao Wang
- 1 Department of Spine Surgery, Zhongda Hospital, Southeast University , Nanjing, China .,2 Surgery Research Center, Medical School of Southeast University , Nanjing, China
| | - Xiao-Tao Wu
- 1 Department of Spine Surgery, Zhongda Hospital, Southeast University , Nanjing, China .,2 Surgery Research Center, Medical School of Southeast University , Nanjing, China
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Xu H, Liu X, Liu G, Zhao J, Fu Q, Xu B. Learning curve of full-endoscopic technique through interlaminar approach for L5/S1 disk herniations. Cell Biochem Biophys 2015; 70:1069-74. [PMID: 24839114 DOI: 10.1007/s12013-014-0024-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Although minimally invasive full-endoscopic (FE) spine surgery through the interlaminar approach has proved safe and effective for surgical treatment of lumbar disk herniation, the learning curve of the procedure has not been sufficiently established. The purpose of this study is to determine the learning curve for the FE surgery through interlaminar approach for treating the L5/S1 disk herniation. Thirty-six patients with lumbar disk herniation (L5/S1 segment) who underwent FE lumbar discectomy through the interlaminar approach between March 2011 and March 2012 were equally divided into Group A, B, and C by the study time of the surgeons. Clinical evaluation data included perioperative parameters (operative duration, intraoperative blood loss, and the amount of intraoperative bone and ligament excision), clinical curative effect index [visual analog scale (VAS) score for leg and back pain], complications, and the rate of conversion to open surgery. The operation duration, intraoperative bleeding, and the amount of bone and ligament excision were gradually and significantly reduced in the Groups A, B, and C (P < 0.01) and reflected in steep curves of proficiency suggesting that the rate of learning was fast. The VAS scores of leg and back pain were significantly improved (P < 0.01) and no symptomatic recurrence was noticed during the follow-up period (1-1.5 years). The outcomes the three groups were not significantly different. The clinical outcomes of the minimally invasive surgery for the treatment of L5/S1 segment disk herniation through the interlaminar approach were excellent suggesting of a satisfactory curative effect. The steep learning curves of perioperative parameters plotted against the number of surgeries conducted suggest that proficiency can be reached reasonably fast.
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Affiliation(s)
- Haidong Xu
- Department of Orthopedics of Jinling Hospital, Nanjing University School of Medicine, 305 Zhongshan East Road, Nanjing, Jiangsu, 210002, China
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Thaler M, Lechner R, Foedinger B, Haid C, Kavakebi P, Galiano K, Obwegeser A. Driving reaction time before and after surgery for disc herniation in patients with preoperative paresis. Spine J 2015; 15:918-22. [PMID: 23993038 DOI: 10.1016/j.spinee.2013.06.052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 03/28/2013] [Accepted: 06/15/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The effect of many types of surgeries on driving reaction time (DRT) has been reported. Although lumbar disc herniation is one of the most common spinal diseases, the effect on DRT has not been investigated. PURPOSE To assess the effect of left- and right-sided pareses caused by lumbar disc herniation on DRT before and after surgery. STUDY DESIGN Controlled prospective clinical trial. PATIENT SAMPLE Patients undergoing disc surgery. OUTCOME MEASURES Impact of paresis caused by lumbar disc herniation and disc surgery on DRT. METHODS Forty-two consecutive patients (mean age, 50.3 years) were tested for DRT 1 day before surgery, postoperatively before hospital discharge, and 5 weeks after surgery. Visual analogue scale (VAS) for back and leg pain as well as pain medication and patients' driving frequency were recorded. RESULTS Significant improvement of DRT after surgery was seen in patients with left- and right-sided pareses (p<.005). For the right-sided paresis group, the preoperative DRT was 761 ms (median, interquartile range [IQR]: 490), 711 ms (median, IQR: 210) immediately postoperatively, and 645 ms (median, IQR: 150) at follow-up (FU). For the left-sided paresis group, DRT was 651 ms (median, IQR: 270) preoperatively, 592 ms (median, IQR: 260) postoperatively, and 569 ms (median, IQR: 140) at FU. Significant differences between right- and left-sided pareses were identified preoperatively and at FU testing (p<.005). No correlation was found between VAS for leg or back pain and DRT. Historical control subjects had a DRT of 487 (median, IQR: 116), which differed significantly at all three test times (p<.001). CONCLUSIONS A significant reduction in DRT in patients with right- and left-sided pareses was found after surgery, indicating a positive effect of surgery. The improvement in DRT seen immediately postoperatively and the lack of a generally accepted threshold for DRT would suggest that for both patient samples, it is safe to continue driving after hospital discharge. However, patients should be informed accordingly.
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Affiliation(s)
- Martin Thaler
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria.
| | - Ricarda Lechner
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Bernhard Foedinger
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Christian Haid
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Pujan Kavakebi
- Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Klaus Galiano
- Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
| | - Alois Obwegeser
- Department of Neurosurgery, Innsbruck Medical University, Anichstrasse 35, A-6020 Innsbruck, Austria
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Bourgeois AC, Faulkner AR, Pasciak AS, Bradley YC. The evolution of image-guided lumbosacral spine surgery. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:69. [PMID: 25992368 PMCID: PMC4402607 DOI: 10.3978/j.issn.2305-5839.2015.02.01] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Accepted: 01/26/2015] [Indexed: 12/19/2022]
Abstract
Techniques and approaches of spinal fusion have considerably evolved since their first description in the early 1900s. The incorporation of pedicle screw constructs into lumbosacral spine surgery is among the most significant advances in the field, offering immediate stability and decreased rates of pseudarthrosis compared to previously described methods. However, early studies describing pedicle screw fixation and numerous studies thereafter have demonstrated clinically significant sequelae of inaccurate surgical fusion hardware placement. A number of image guidance systems have been developed to reduce morbidity from hardware malposition in increasingly complex spine surgeries. Advanced image guidance systems such as intraoperative stereotaxis improve the accuracy of pedicle screw placement using a variety of surgical approaches, however their clinical indications and clinical impact remain debated. Beginning with intraoperative fluoroscopy, this article describes the evolution of image guided lumbosacral spinal fusion, emphasizing two-dimensional (2D) and three-dimensional (3D) navigational methods.
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Affiliation(s)
- Austin C Bourgeois
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
| | - Austin R Faulkner
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
| | - Alexander S Pasciak
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
| | - Yong C Bradley
- 1 University of Tennessee Graduate School of Medical Education, 1924 Alcoa Highway, Knoxville, TN 37919, USA ; 2 Department of Radiology, University of Tennessee Medical Center, 1924 Alcoa Highway, Knoxville, TN 37919, USA
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106
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Cong L, Zhu Y, Tu G. A meta-analysis of endoscopic discectomy versus open discectomy for symptomatic lumbar disk herniation. 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 2015; 25:134-143. [PMID: 25632840 DOI: 10.1007/s00586-015-3776-6] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 12/13/2014] [Accepted: 01/19/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE The purpose of this study was to systematically compare the effectiveness and safety of endoscopic discectomy (ED) with open discectomy (OD) for the treatment of symptomatic lumbar disc herniation (LDH). METHODS A highly sensitive search strategy was used to identify all published randomized controlled trials up to August 2014. A criteria list taken from Koes et al. was used to evaluate the risk of bias of the included studies. The five questions that were recommended by the Cochrane Back Review Group were used to evaluate the clinical relevance. Cochrane methodology was used for the results of this meta-analysis. RESULTS Nine relevant RCTs involving 1,092 patients were identified. Compared with OD, ED results in slightly better clinical outcomes which were evaluated by the Macnab criteria without clinical significance (ED group: 95.76 %; OD group: 80 %; OR: 3.72, 95 % CI: [0.76, 18.14], P = 0.10), a significantly greater patient satisfaction rate (ED group: 93.21 %; OD group: 86.57 %; OR: 2.19; 95 % CI: [1.09, 4.40]; P = 0.03), lower intraoperative blood loss volume (WMD: -123.71, 95 % CI: [-173.47, -73.95], P < 0.00001), and shorter length of hospital stay (WMD: -Table 2144.45, 95 % CI: [-239.54, -49.37], P = 0.003). CONCLUSIONS From the existing outcomes, ED surgery could be viewed as a sufficient and safe supplementation and alternative to standard open discectomy. The cost-effectiveness analyses still remain unproved from the existing data. More independent high-quality RCTs using sufficiently large sample sizes with cost-effectiveness analyses are needed.
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Affiliation(s)
- Lin Cong
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China.
| | - Yue Zhu
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
| | - Guanjun Tu
- Department of Orthopaedics, The First Affiliated Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 110001, Liaoning, People's Republic of China
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107
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Gore S, Yeung A. The "inside out" transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature. Int J Spine Surg 2014; 8:14444-1028. [PMID: 25694940 PMCID: PMC4325508 DOI: 10.14444/1028] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Surgical management of back and leg pain is evolving and changing due to a better understanding of the patho-anatomy well correlated with its pathophysiology. Pain is better understood with in vivo visualization and probing of the pain generators using an endoscopic access rather than just relying on symptoms diagram and image correlation. This has resulted in a shared decision making involving patient and surgeon, focused on a broader spectrum of surgical as well as non-surgical treatments, and not just masking the pain generator. It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy. The ability to isolate and visualize "pain" generators in the foramen and treating persistent pain by visualizing inflammation and compression of nerves, serves as the basis for transforaminal endoscopic (TFE) surgery. This has also resulted in better pre surgical planning with more specific and defined goals in mind. The "Inside out" philosophy of TFE surgery is safe and precise. It provides basic access to the disc and foramen to cover a large spectrum of painful pathologies.
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108
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Sencer A, Yorukoglu AG, Akcakaya MO, Aras Y, Aydoseli A, Boyali O, Sencan F, Sabanci PA, Gomleksiz C, Imer M, Kiris T, Hepgul K, Unal OF, Izgi N, Canbolat AT. Fully Endoscopic Interlaminar and Transforaminal Lumbar Discectomy: Short-Term Clinical Results of 163 Surgically Treated Patients. World Neurosurg 2014; 82:884-90. [DOI: 10.1016/j.wneu.2014.05.032] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/07/2013] [Accepted: 05/29/2014] [Indexed: 10/25/2022]
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Rasouli MR, Rahimi‐Movaghar V, Shokraneh F, Moradi‐Lakeh M, Chou R. Minimally invasive discectomy versus microdiscectomy/open discectomy for symptomatic lumbar disc herniation. Cochrane Database Syst Rev 2014; 2014:CD010328. [PMID: 25184502 PMCID: PMC10961733 DOI: 10.1002/14651858.cd010328.pub2] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Microdiscectomy or open discectomy (MD/OD) are the standard procedures for symptomatic lumbar disc herniation and they involve removal of the portion of the intervertebral disc compressing the nerve root or spinal cord (or both) with or without the aid of a headlight loupe or microscope magnification. Potential advantages of newer minimally invasive discectomy (MID) procedures over standard MD/OD include less blood loss, less postoperative pain, shorter hospitalisation and earlier return to work. OBJECTIVES To compare the benefits and harms of MID versus MD/OD for management of lumbar intervertebral discopathy. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (November 2013), MEDLINE (1946 to November 2013) and EMBASE (1974 to November 2013) and applied no language restrictions. We also contacted experts in the field for additional studies and reviewed reference lists of relevant studies. SELECTION CRITERIA We selected randomised controlled trials (RCTs) and quasi-randomised controlled trials (QRCTs) that compared MD/OD with a MID (percutaneous endoscopic interlaminar or transforaminal lumbar discectomy, transmuscular tubular microdiscectomy and automated percutaneous lumbar discectomy) for treatment of adults with lumbar radiculopathy secondary to discopathy. We evaluated the following primary outcomes: pain related to sciatica or low back pain (LBP) as measured by a visual analogue scale, sciatic specific outcomes such as neurological deficit of lower extremity or bowel/urinary incontinence and functional outcomes (including daily activity or return to work). We also evaluated the following secondary outcomes: complications of surgery, duration of hospital stay, postoperative opioid use, quality of life and overall participant satisfaction. Two authors checked data abstractions and articles for inclusion. We resolved discrepancies by consensus. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by The Cochrane Collaboration. We used pre-developed forms to extract data and two authors independently assessed risk of bias. For statistical analysis, we used risk ratio (RR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with 95% confidence intervals (CI) for each outcome. MAIN RESULTS We identified 11 studies (1172 participants). We assessed seven out of 11 studies as having high overall risk of bias. There was low-quality evidence that MID was associated with worse leg pain than MD/OD at follow-up ranging from six months to two years (e.g. at one year: MD 0.13, 95% CI 0.09 to 0.16), but differences were small (less than 0.5 points on a 0 to 10 scale) and did not meet standard thresholds for clinically meaningful differences. There was low-quality evidence that MID was associated with worse LBP than MD/OD at six-month follow-up (MD 0.35, 95% CI 0.19 to 0.51) and at two years (MD 0.54, 95% CI 0.29 to 0.79). There was no significant difference at one year (0 to 10 scale: MD 0.19, 95% CI -0.22 to 0.59). Statistical heterogeneity was small to high (I(2) statistic = 35% at six months, 90% at one year and 65% at two years). There were no clear differences between MID techniques and MD/OD on other primary outcomes related to functional disability (Oswestry Disability Index greater than six months postoperatively) and persistence of motor and sensory neurological deficits, though evidence on neurological deficits was limited by the small numbers of participants in the trials with neurological deficits at baseline. There was just one study for each of the sciatica-specific outcomes including the Sciatica Bothersomeness Index and the Sciatica Frequency Index, which did not need further analysis. For secondary outcomes, MID was associated with lower risk of surgical site and other infections, but higher risk of re-hospitalisation due to recurrent disc herniation. In addition, MID was associated with slightly lower quality of life (less than 5 points on a 100-point scale) on some measures of quality of life, such as some physical subclasses of the 36-item Short Form. Some trials found MID to be associated with shorter duration of hospitalisation than MD/OD, but results were inconsistent. AUTHORS' CONCLUSIONS MID may be inferior in terms of relief of leg pain, LBP and re-hospitalisation; however, differences in pain relief appeared to be small and may not be clinically important. Potential advantages of MID are lower risk of surgical site and other infections. MID may be associated with shorter hospital stay but the evidence was inconsistent. Given these potential advantages, more research is needed to define appropriate indications for MID as an alternative to standard MD/OD.
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Affiliation(s)
- Mohammad R Rasouli
- Thomas Jefferson University HospitalRothman Institute at Jefferson925 Chestnut Street, 5th FloorPhiladelphiaPAUSA19107‐4216
| | - Vafa Rahimi‐Movaghar
- Tehran University of Medical SciencesSina Trauma and Surgery Research Center, Sina HospitalHassan‐Abad Square, Imam Khomeini AveTehranTehranIran11365‐3876
| | - Farhad Shokraneh
- The Institute of Mental Health, a partnership between the University of Nottingham and Nottinghamshire Healthcare NHS TrustCochrane Schizophrenia GroupJubilee CampusNottinghamUKNG7 2TU
| | - Maziar Moradi‐Lakeh
- Iran University of Medical SciencesDepartment of Community MedicineTehranTehranIran
| | - Roger Chou
- Oregon Health & Science UniversityDepartment of Medical Informatics & Clinical Epidemiology3181 SW Sam Jackson Park Rd.Mail Code: BICCPortlandOregonUSA97239
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Liao Z, Chen W, Wang CH. Transforaminal percutaneous endoscopic surgery for far lateral lumbar intervertebral disk herniation. Orthopedics 2014; 37:e717-27. [PMID: 25102508 DOI: 10.3928/01477447-20140728-58] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Accepted: 01/30/2014] [Indexed: 02/03/2023]
Abstract
Far lateral lumbar intervertebral disk herniation (FLLIDH) most commonly occurs far lateral to the intervertebral facet at L3-L4 and L4-L5 and accounts for 3.8% of all lumbar disk herniations. Traditional surgery for FLLIDH involves massive surgical trauma, damage to the spinal structure, and instability of the lumbar spine. The goals of this study were to perform a systematic review of the literature and investigate the clinical outcomes of transforaminal percutaneous endoscopic surgery in the treatment of FLLIDH. Between October 2010 and May 2012, fifteen patients diagnosed with FLLIDH underwent transforaminal percutaneous endoscopic surgery at the authors' institution to remove the herniated disk and release the nerve root. Pain was measured pre- and postoperatively with a visual analog pain scale (VAS), and postoperative outcomes were evaluated using MacNab's criteria. A PubMed database search was conducted for the systematic review. Median operative time was 100 minutes (range, 80-140 minutes). Median volume of intraoperative blood loss was 20 mL (range, 10-50 mL). Patients were followed postoperatively for a median of 6 months (range, 1-12 months). MacNab's criteria rated 12 (80.0%) surgical outcomes as excellent, 2 (13.3%) as good, and 1 (6.7%) as fair. The systematic review included 14 studies. Transforaminal percutaneous endoscopic surgery appears to be a safe and effective minimally invasive procedure for treating FLLIDH. However, as demand for this type of surgery increases, the possibility of intraoperative aggravated leg pain and compression injury of the ganglion must be considered.
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111
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Abstract
Percutaneous endoscopic lumbar discectomy has become a representative minimally invasive spine surgery for lumbar disc herniation. Due to the remarkable evolution in the techniques available, the paradigm of spinal endoscopy is shifting from treatments of soft disc herniation to those of lumbar spinal stenosis. Lumbar spinal stenosis can be classified into three categories according to pathological zone as follows: central stenosis, lateral recess stenosis and foraminal stenosis. Moreover, percutaneous endoscopic decompression (PED) techniques may vary according to the type of lumbar stenosis, including interlaminar PED, transforaminal PED and endoscopic lumbar foraminotomy. However, these techniques are continuously evolving. In the near future, PED for lumbar stenosis may be an efficient alternative to conventional open lumbar decompression surgery.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
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112
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Wang X, Zeng J, Nie H, Chen G, Li Z, Jiang H, Kong Q, Song Y, Liu H. Percutaneous endoscopic interlaminar discectomy for pediatric lumbar disc herniation. Childs Nerv Syst 2014; 30:897-902. [PMID: 24301611 DOI: 10.1007/s00381-013-2320-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2013] [Accepted: 11/05/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure which shows satisfying outcomes in the adult population. However, pediatric lumbar disc herniations (PLDH) occur in growing spines and are less related to degeneration, which makes them different from the adult disc herniations. This study evaluates the clinical outcomes of PEID in treating PLDH. METHODS A prospect study was done in the period from June 2010 to December 2012, which included 29 consecutive pediatric patients with a mean age of 16.4 years (range, 13 to 18 years) who underwent PEID for single level lumbar disc herniation. The following measuring tools were used: visual analog scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and Macnab criteria. RESULTS There were no severe complications such as dural tear or nerve root damage found in our study. The mean follow-up period was 19.7 months. The VAS score for leg and back pain decreased dramatically at 1 day postoperatively and kept decreasing until the follow-up visit at 3 months postoperatively, when it became stable at a low level. ODI kept improving until the follow-up visit at 6 months postoperatively when it reached a stable low level. Of the patients, 91% reported no longer having leg pain and 9% had occasional leg pain at last follow-up. CONCLUSIONS PEID shows a satisfying outcome with a minimal rate of complications. It has the advantages of minimal traumatization and scar formation and is a safe and effective treatment for PLDH.
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Affiliation(s)
- Xiandi Wang
- Department of Orthopedic Surgery, West China Hospital of Sichuan University, No. 37 Guo Xue Xiang St, 610041, Chengdu, Sichuan, People's Republic of China
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113
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Pan L, Zhang P, Yin Q. Comparison of tissue damages caused by endoscopic lumbar discectomy and traditional lumbar discectomy: a randomised controlled trial. Int J Surg 2014; 12:534-7. [PMID: 24583364 DOI: 10.1016/j.ijsu.2014.02.015] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 01/16/2014] [Accepted: 02/26/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study aimed to compare the clinical efficacies of percutaneous endoscopic lumbar discectomy (PELD) and traditional open lumbar discectomy (OD). METHODS The pre-operative and post-operative blood loss, hospital stays and wound sizes of the patients in the two groups were recorded. Enzyme-Linked immunosorbent assay was used to measure the changes of interleukin-6 (IL-6), C-reactive protein (CRP) and creatine phosphokinase (CPK) pre-operation and 1 h, 6 h, 12 h, 24 h and 48 h after corresponding surgery. Visual Analog Scale and Modified MacNab Criteria were used to assess post-operative results. RESULTS Patients in the PELD group had less blood loss (p < 0.01), shorter hospitalization hours (p < 0.01) and smaller surgical wounds (p < 0.01) than the patients underwent traditional OD surgery. MacNab evaluated that the levels of satisfaction were above 90% in both groups post-operative six months. There was no significant difference in pain index between the two groups (p > 0.05). Furthermore, the levels of CRP, CPK and IL-6 in the PELD group were all lower than those in the OD group with a significant difference (p < 0.01). CONCLUSION The PELD had less damage to human tissues than the traditional OD. PELD has a clear promotional value in clinical.
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Affiliation(s)
- Lei Pan
- Department of Orthopaedics Surgery, The People's Hospital of Foshan, Sanshui District, Foshan 528100, Guangdong Province, China
| | - Peifang Zhang
- Department of Respiratory Medicine, The First People's Hospital of Foshan, Foshan 528000, Guangdong Province, China
| | - Qingshui Yin
- Department of Orthopaedics Surgery, Liuhuaqiao Hospital, Guangzhou 510010, Guangdong Province, China.
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Foraminoplastic transfacet epidural endoscopic approach for removal of intraforaminal disc herniation at the L5-S1 level. Wideochir Inne Tech Maloinwazyjne 2014; 9:96-100. [PMID: 24729817 PMCID: PMC3983545 DOI: 10.5114/wiitm.2014.40186] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 07/22/2013] [Accepted: 08/10/2013] [Indexed: 12/03/2022] Open
Abstract
Transforaminal endoscopic disc removal in the L5-S1 motion segment of the lumbar spine creates a technical challenge due to anatomical reasons and individual variability. The majority of surgeons prefer a posterior classical or minimally invasive approach. There is only one foraminoplastic modification of the technique in the literature so far. In this paper we present a new technique with a foraminoplastic transfacet approach that may be suitable in older patients with advanced degenerative disease of the spine.
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115
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Kamper SJ, Ostelo RWJG, Rubinstein SM, Nellensteijn JM, Peul WC, Arts MP, van Tulder MW. Minimally invasive surgery for lumbar disc herniation: a systematic review and meta-analysis. 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 2014. [PMID: 24442183 DOI: 10.1007/s00586-013-316-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Assessing the benefits of surgical treatments for sciatica is critical for clinical and policy decision-making. To compare minimally invasive (MI) and conventional microdiscectomy (MD) for patients with sciatica due to lumbar disc herniation. METHODS A systematic review and meta-analysis of controlled clinical trials including patients with sciatica due to lumbar disc herniation. Conventional microdiscectomy was compared separately with: (1) Interlaminar MI discectomy (ILMI vs. MD); (2) Transforaminal MI discectomy (TFMI vs. MD). OUTCOMES Back pain, leg pain, function, improvement, work status, operative time, blood loss, length of hospital stay, complications, reoperations, analgesics and cost outcomes were extracted and risk of bias assessed. Pooled effect estimates were calculated using random effect meta-analysis. RESULTS Twenty-nine studies, 16 RCTs and 13 non-randomised studies (n = 4,472), were included. Clinical outcomes were not different between the surgery types. There is low quality evidence that ILMI takes 11 min longer, results in 52 ml less blood loss and reduces mean length of hospital stay by 1.5 days. There were no differences in complications or reoperations. The main limitations were high risk of bias, low number of studies and small sample sizes comparing TF with MD. CONCLUSIONS There is moderate to low quality evidence of no differences in clinical outcomes between MI surgery and conventional microdiscectomy for patients with sciatica due to lumbar disc herniation. Studies comparing transforaminal MI with conventional surgery with sufficient sample size and methodological robustness are lacking.
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Affiliation(s)
- Steven J Kamper
- Department of Epidemiology and Biostatistics, VU University Medical Centre, The EMGO+ Institute for Health and Care Research, Vander Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands,
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Minimally invasive surgery for lumbar disc herniation: a systematic review and meta-analysis. 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 2014; 23:1021-43. [PMID: 24442183 DOI: 10.1007/s00586-013-3161-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 12/28/2013] [Accepted: 12/29/2013] [Indexed: 10/25/2022]
Abstract
PURPOSE Assessing the benefits of surgical treatments for sciatica is critical for clinical and policy decision-making. To compare minimally invasive (MI) and conventional microdiscectomy (MD) for patients with sciatica due to lumbar disc herniation. METHODS A systematic review and meta-analysis of controlled clinical trials including patients with sciatica due to lumbar disc herniation. Conventional microdiscectomy was compared separately with: (1) Interlaminar MI discectomy (ILMI vs. MD); (2) Transforaminal MI discectomy (TFMI vs. MD). OUTCOMES Back pain, leg pain, function, improvement, work status, operative time, blood loss, length of hospital stay, complications, reoperations, analgesics and cost outcomes were extracted and risk of bias assessed. Pooled effect estimates were calculated using random effect meta-analysis. RESULTS Twenty-nine studies, 16 RCTs and 13 non-randomised studies (n = 4,472), were included. Clinical outcomes were not different between the surgery types. There is low quality evidence that ILMI takes 11 min longer, results in 52 ml less blood loss and reduces mean length of hospital stay by 1.5 days. There were no differences in complications or reoperations. The main limitations were high risk of bias, low number of studies and small sample sizes comparing TF with MD. CONCLUSIONS There is moderate to low quality evidence of no differences in clinical outcomes between MI surgery and conventional microdiscectomy for patients with sciatica due to lumbar disc herniation. Studies comparing transforaminal MI with conventional surgery with sufficient sample size and methodological robustness are lacking.
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Endoscopic transforaminal thoracic foraminotomy and discectomy for the treatment of thoracic disc herniation. Minim Invasive Surg 2013; 2013:264105. [PMID: 24455232 PMCID: PMC3880763 DOI: 10.1155/2013/264105] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 11/18/2013] [Indexed: 02/05/2023] Open
Abstract
Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery.
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Abstract
We aimed to evaluate the available evidence on the effectiveness of surgical interventions for a number of conditions resulting in low back pain (LBP) or spine-related irradiating leg pain. We searched the Cochrane databases and PubMed up to June 2013. We included systematic reviews and randomised controlled trials (RCTs) on degenerative disc disease (DDD), herniated disc, spondylolisthesis and spinal stenosis due to degenerative osteoarthritis. We included comparisons between surgery and conservative care and between different techniques. The quality of the systematic reviews was evaluated using assessment of multiple systematic reviews (AMSTAR). Twenty systematic reviews were included which covered the following diagnoses: disc herniation (n = 9), spondylolisthesis (n = 2), spinal stenosis (n = 3), DDD (n = 4) and combinations (n = 2). For most of the comparisons, no significant and/or clinically relevant differences between interventions were identified. In general, surgery is only indicated for relief of leg pain in clear indications such as disc herniation, spondylolisthesis or spinal stenosis.
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Prospective randomized trial of chemonucleolysis compared with surgery for soft disc herniation with 1-year, intermediate, and long-term outcome: part I: the clinical outcome. Spine (Phila Pa 1976) 2013; 38:E1051-7. [PMID: 23609203 DOI: 10.1097/brs.0b013e31829729b3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A prospective consecutive series of 100 patients computer randomized into 2 groups to have treatment by either chemonucleolysis or surgery. OBJECTIVE To compare the complications and clinical outcome between the groups at 1 year, and at 10 to 13 and 24 to 27 years. SUMMARY OF BACKGROUND DATA Chemonucleolysis was introduced in 1964 and became widely used. Its efficacy was proven by several randomized studies when compared with a placebo and surgery. The manufacturing of Chemonucleolysis was ceased in 2001. METHODS One hundred consecutive patients were enrolled for the study and randomized according to age, sex, and disc level. They were followed up at 1 year with self-assessment questionnaires to establish if they were completely better, improved, the same or worse. At 10 to 13 years, 61 patients (32 chemonuceolysis and 29 surgery) and at 24 to 27 years, 45 patients (24 chemonucleolysis and 21 surgery) were self-assessed by questionnaire according to the Macnab criteria. RESULTS Forty-eight patients were treated by chemonucleolysis and 52 by surgery. Ten patients treated by chemonucleolysis underwent surgery within 8 weeks. At 1 year, 10 to 13 years, and 24 to 27 years, 94%, 72%, and 63% of patients treated by chemonucleolysis had good or excellent results compared with 96%, 72%, and 67% of patients who underwent surgery, respectively. There was no difference in the clinical outcome between the treatments at any of the follow-up time points. There were 2 serious complications, 1in each treatment group. CONCLUSION Chemonucleolysis is as effective as surgery when assessed according to intention-to-treat analysis, with reduced complications, and age has no bearing on the outcome. The authors think that restoration of its availability would be beneficial to patients. LEVEL OF EVIDENCE 1.
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Xin G, Shi-Sheng H, Hai-Long Z. Morphometric analysis of the YESS and TESSYS techniques of percutaneous transforaminal endoscopic lumbar discectomy. Clin Anat 2013; 26:728-34. [PMID: 23824995 DOI: 10.1002/ca.22286] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/23/2013] [Accepted: 06/05/2013] [Indexed: 11/06/2022]
Abstract
Posterior lateral endoscopic nucleotomy is widely accepted as a minimally invasive surgery for lumbar disc herniation, but few studies have compared the transforaminal approach using two different techniques, YESS and TESSYS. One hundred and fifty lumbar IVFs of cadaveric spines were studied. Eighteen-gauge needles were inserted percutaneously toward IVFs into the discs by either YESS or TESSYS. The distances from the needle to the nerve root and from the needle to the spinal dura were measured and compared across different spinal segments. The incidence of nerve roots compression by the operating endoscope was measured. The mean distances from needle to the nerve root and spinal dura in YESS were 3.5 ± 1.4 mm and 6.6 ± 1.9 mm. The respective mean distances in TESSYS were 4.6 ± 1.5 mm and 5.9 ± 1.4 mm. The distance from needle to the nerve root was longer in TESSYS, while the distance from the needle to spinal dura was longer in YESS. The distance from needle to nerve was shorter in proximal segments. The incidence of operating endoscope compression of the nerve root was high in both of techniques. The difference in theory and design between YESS and TESSYS, "intradisc" versus "intracanal", was confirmed by comparison of anatomic distances from the needle to the nerve. Puncture of the annulus in the distal lumbar is safer than proximal puncture. The high incidence of endoscope compression of the nerve root may be related with the transient postoperative dysaesthesia.
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Affiliation(s)
- Gu Xin
- Department of Orthopaedics, Shanghai Tenth People's Hospital Affiliated to Tongji University, Shanghai, China
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The evidence on surgical interventions for low back disorders, an overview of systematic reviews. 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 2013; 22:1936-49. [PMID: 23681497 DOI: 10.1007/s00586-013-2823-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 03/21/2013] [Accepted: 05/06/2013] [Indexed: 01/08/2023]
Abstract
PURPOSE Many systematic reviews have been published on surgical interventions for low back disorders. The objective of this overview was to evaluate the available evidence from systematic reviews on the effectiveness of surgical interventions for disc herniation, spondylolisthesis, stenosis, and degenerative disc disease (DDD). An earlier version of this review was published in 2006 and since then, many new, better quality reviews have been published. METHODS A comprehensive search was performed in the Cochrane database of systematic reviews (CDSR), database of reviews of effectiveness (DARE) and Pubmed. Two reviewers independently performed the selection of studies, risk of bias assessment, and data extraction. Included are Cochrane reviews and non-Cochrane systematic reviews published in peer-reviewed journals. The following conditions were included: disc herniation, spondylolisthesis, and DDD with or without spinal stenosis. The following comparisons were evaluated: (1) surgery vs. conservative care, and (2) different surgical techniques compared to one another. The methodological quality of the systematic reviews was evaluated using AMSTAR. We report (pooled) analyses from the individual reviews. RESULTS Thirteen systematic reviews on surgical interventions for low back disorders were included for disc herniation (n = 6), spondylolisthesis (n = 2), spinal stenosis (n = 4), and DDD (n = 4). Nine (69 %) were of high quality. Five reviews provided a meta-analysis of which two showed a significant difference. For the treatment of spinal stenosis, intervertebral process devices showed more favorable results compared to conservative treatment on the Zurich Claudication Questionnaire [mean difference (MD) 23.2 95 % CI 18.5-27.8]. For degenerative spondylolisthesis, fusion showed more favorable results compared to decompression for a mixed aggregation of clinical outcome measures (RR 1.40 95 % CI 1.04-1.89) and fusion rate favored instrumented fusion over non-instrumented fusion (RR 1.37 95 % CI 1.07-1.75). CONCLUSIONS For most of the comparisons, the included reviews were not significant and/or clinically relevant differences between interventions were identified. Although the quality of the reviews was quite acceptable, the quality of the included studies was poor. Future studies are likely to influence our assessment of these interventions.
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Blamoutier A. Surgical discectomy for lumbar disc herniation: surgical techniques. Orthop Traumatol Surg Res 2013; 99:S187-96. [PMID: 23352565 DOI: 10.1016/j.otsr.2012.11.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 11/23/2012] [Indexed: 02/02/2023]
Abstract
Discectomy for lumbar discal herniation is the most commonly performed spinal surgery. The basic principle of the various techniques is to relieve the nerve root compression induced by the herniation. Initially, the approach was a unilateral posterior 5-cm incision: the multifidus was detached from the vertebra, giving access through an interlaminar space in case of posterolateral herniation; an alternative paraspinal approach was used for extraforaminal herniation. Over the past 30 years, many technical improvements have decreased operative trauma by reducing incision size, thereby reducing postoperative pain and hospital stay and time off work, while improving clinical outcome. Magnification and illumination systems by microscope and endoscope have been introduced to enable minimally invasive techniques. Several comparative studies have analyzed the clinical results of these various techniques. Although the methodology of most of these studies is debatable, all approaches seem to provide clinical outcomes of similar quality. At all events, minimally invasive techniques reduce hospital stay. While technical proficiency is essential, the final result depends on strict compliance with a prerequisite for surgical indication: close correlation between clinical symptoms and radiological findings. It is essential to discuss the risk/benefit ratio and explain the pros and cons of the recommended technique to the patient.
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Affiliation(s)
- A Blamoutier
- Saint-Grégoire Private Hospital Center, 6 boulevard de la Boutière, Saint-Grégoire, France.
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Use of the video telescope operating monitor (VITOM) as an alternative to the operating microscope in spine surgery. Spine (Phila Pa 1976) 2012; 37:E1517-23. [PMID: 23151873 DOI: 10.1097/brs.0b013e3182709cef] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To evaluate the efficacy of video telescope operating monitor (VITOM) as an alternative to operative microscope (OM) in spinal surgery. SUMMARY OF BACKGROUND DATA The surgical operating microscope can be expensive, cumbersome, and ergonomically disadvantageous. VITOM is a novel telescope-based exoscope system that can be used as an alternative or supplement to OM. METHODS Patients undergoing spinal surgery were enrolled in a prospective cohort study between December 2008 and March 2011. Age, sex, and operation-matched patients undergoing surgery using the standard OM served as the control group. During surgery, the VITOM system was used in place of the OM in 24 patients. Operative time, length of postoperative hospital stay, and intraoperative complications were assessed. RESULTS.: A total of 48 patients were studied in 2 equal cohorts of 24 patients each. Within each cohort, patients underwent single-level (n = 4) and 2-level (n = 7) posterior decompression as well as single-level (n = 11) and 2-level (n = 2) transforaminal lumbar interbody fusions via VITOM, with an equal number of controls using OM. There were no significant differences in age (P = 0.79) or sex (P = 0.77) between cohorts.There were no statistically significant differences in mean operative room time for single-level decompressions (P = 0.38), 2-level decompressions (P = 0.12), single-level transforaminal lumbar interbody fusions (P = 0.13), or 2-level transforaminal lumbar interbody fusions (P = 0.15). Postoperative hospital length of stay averaged 2.9 days for the VITOM group versus 2.8 days for the traditional OM group (P = 0.75). There were no intraoperative complications in either group. Subjectively, surgeons rated the image quality as very high and equal to the OM. CONCLUSION The VITOM system for spinal surgery provides outstanding image quality and an ease of manipulation rivaling the OM. There were no statistically significant differences in mean operative room time, intraoperative complications, or total hospital length of stay when using this novel system in several common spinal procedures relative to the OM.
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124
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Percutaneous endoscopic treatment of foraminal and extraforaminal disc herniation at the L5-S1 level. Acta Neurochir (Wien) 2012; 154:1789-95. [PMID: 22782651 DOI: 10.1007/s00701-012-1432-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 06/20/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND Microsurgery of foraminal and extraforaminal disc herniation at the L5-S1 level remains a challenge because of the limited access by a high iliac crest, the sacral ala, large transverse processes of L5 and hidden disc fragments lateral to the zygapophyseal joint. Our aim was to present the outcome of percutaneous endoscopic lumbar discectomy (PELD) of these lateral and far lateral disc herniations at the L5-S1 level using the newly described foraminal retreat technique in a group of patients with similar preoperative diagnostic studies. METHODS A total of 22 patients, 13 males and 9 females, with foraminal and extraforaminal lumbar disc herniation at the L5-S1 level were treated by applying the PELD between September 2004 and April 2010. The clinical findings and MRI were the main diagnostic methods. Preoperative evaluation was performed with clinical examinations, the Visual Analog Pain Scale (VAS) and Oswestry Low Back Disability Index (ODI). FINDINGS According to the Macnab criteria, overall excellent or good outcomes were obtained in 18 patients (81.8 %), fair outcomes in 3 patients (13.6 %) and a poor outcome in 1 patient (4.5 %) at the last follow-up. The mean ODI was 67.3 ± 19.4 preoperatively and 26.7 ± 23.4 postoperatively. Preoperative VAS was 88.6 ± 7.6 and 28.6 ± 22.8 at 2 days, 40.5 ± 22.8 at 3 weeks, 34.3 ± 25.1 at 6-months and 32 at the last follow-up. At follow-up, two patients (9.1 %) had recurrent disc herniations that were corrected with open surgery. At the time of surgery, 16 patients held jobs. Fifteen (15) patients (93.8 %) returned to their original jobs postoperatively; one patient could not return to his original job postoperatively because of a comorbidity. CONCLUSIONS Percutaneous endoscopic discectomy using the foraminal retreat technique is an effective treatment method for patients with foraminal and extraforaminal disc herniations at the L5-S1 level on appropriately selected patients.
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The projection of nerve roots on the posterior aspect of spine from T11 to L5: a cadaver and radiological study. Spine (Phila Pa 1976) 2012; 37:E1232-7. [PMID: 22744616 DOI: 10.1097/brs.0b013e318265dd5d] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cadaver and radiological study. OBJECTIVE To investigate the projection of nerve roots on the posterior aspect of the spine from T11 to L5. SUMMARY OF BACKGROUND DATA Understanding the projection of nerve roots on the posterior lamina will help to determine the decompressing areas of lamina and avoiding unnecessary bony resection. It can prevent segmental instability and postoperative scar formation. No studies regarding this subject are available. METHODS Fifteen formalin-preserved spine specimens were used for this study. After exposing the dural sac and bilateral nerve roots, small pieces of stainless steel wires were placed along the root sleeves from their points of origin, and then standard anteroposterior and lateral radiographs were taken. Parameters were measured directly on radiographs using the picture archiving communication system. Measurements included: (1) take-off angles of the nerve roots at the coronal (CA) and sagittal planes (SA); (2) distance from the origin of the root sleeve to the posterior midline (DM); (3) distance from the origin of the root sleeve to the superior (DS) and inferior margin (DI) of its corresponding lamina; and (4) distance between the origins of neighboring nerve roots (DR). RESULTS The CA statistically decreased from T11 (52.4° ± 3.13°) to L5 (25.8° ± 3.10°). An opposite variation tendency was observed in SA. The DS increased from 1.8 ± 0.32 mm for T11 to 5.84 ± 1.05 mm for L5. No consistent change was found at DI. The DR was largest at the L1-L2 interval (33.9 ± 1.40 mm) and it decreased progressively to L4-L5 (25.5 ± 2.40 mm). DM statistically increased from T11 (8.9 ± 1.51 mm) to L1 (10.9 ± 1.11 mm) and then progressively decreased until it reached a minimum at L5 (8.1 ± 0.83 mm). CONCLUSION The precise projection of nerve roots to the posterior aspect of spine and intraspinal take-off angles at the sagittal plane have been presented. Surgical interventions of the lumbar disc and nerve root may benefit from this quantitative anatomical study.
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Billon-Grand R, De Rose F, Katranji H. [Learning curve for lumbar disc surgery]. Neurochirurgie 2012; 58:337-40. [PMID: 22819585 DOI: 10.1016/j.neuchi.2012.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 03/01/2012] [Accepted: 03/02/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Various techniques are available for lumbar disc surgery. But failure and severe adverse events still occur during such procedures. Recent work concluded that the use of microscope was not mandatory for such procedures. METHODS The first 70 spinal procedures for lower limb radicular syndrome by a surgeon at the beginning of this activity where studied. Particular interest was paid on adverse events, especially complications and failures. RESULT Average duration of surgery (50min) and rate of reoperation (six reoperations needed out of 65 patients, five of them by the same surgeon) where, as expected, a bit higher than published in experienced hands. But no battered-root syndrome, injury to neighboring structures or other severe complication was observed. Noteworthy is that no patient was neurologically worsened by surgery. CONCLUSIONS If the use of microscope may not be needed for lumbar disc open surgery in experienced hands, we strongly advice surgeons at the beginning of their practice to use it. At least, to avoid unforgiving mistakes such as picking out the root instead of the herniation.
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Affiliation(s)
- R Billon-Grand
- Service de neurochirurgie, CHU Jean-Minjoz, 25030 Besançon cedex, France.
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Gibson JNA, Cowie JG, Iprenburg M. Transforaminal endoscopic spinal surgery: the future 'gold standard' for discectomy? - A review. Surgeon 2012; 10:290-6. [PMID: 22705355 DOI: 10.1016/j.surge.2012.05.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 03/05/2012] [Accepted: 05/09/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lumbar disc prolapse is common and the primary method of care in most centres is still open discectomy facilitated by microscope or loupe magnification and illumination. Hospitalisation may be less than 24 h, but post-operative pain usually requires an overnight stay. This review describes transforaminal endoscopic spinal surgery (TESS) using HD-video technology, that is generally performed as a day case procedure under sedation or light general anaesthesia, and collates the evidence comparing the technique to microdiscectomy. METHODS The method of TESS is described and an electronic literature search performed to identify papers reporting clinical outcomes. International data were translated where necessary and proceedings' abstracts included. In addition, papers held by the authors and colleagues in personal libraries were carefully cross-referenced to the obtained database. RESULTS Analysis of the data supports the use of a transforaminal endoscopic approach to the lumbar intervertebral disc and suggests that outcomes following surgery are at least equivalent to those following microdiscectomy. Significant cost-savings in terms of in-patient stay may be generated. In addition, there is also some evidence supporting endoscopic surgery for relief of foraminal stenosis. CONCLUSION Based on current evidence there are good arguments supporting a more wide-spread adoption of transforaminal endoscopic surgery for the treatment of lumbar disc prolapse with or without foraminal stenosis.
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Affiliation(s)
- J N Alastair Gibson
- Department of Orthopaedic Surgery, The Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, United Kingdom.
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Thaler M, Lechner R, Foedinger B, Haid C, Kavakebi P, Galiano K, Obwegeser A. Driving reaction time before and after surgery for lumbar disc herniation in patients with radiculopathy. 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 2012; 21:2259-64. [PMID: 22648392 DOI: 10.1007/s00586-012-2378-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/28/2012] [Accepted: 05/10/2012] [Indexed: 12/19/2022]
Abstract
PURPOSE Although patients scheduled to undergo lumbar disc surgery often ask when they are allowed to drive a motor vehicle again, there are no published recommendations on this subject. METHODS We conducted a prospective study in 46 consecutive patients (mean age 48.9 years) to determine driving reaction time (DRT) before and after surgery in patients with lumbar disc herniation. Of the patients 23 had left-side radiculopathy and 23 right-side radiculopathy. Driving reaction time as well as back and leg pain were evaluated preoperatively, on the day of discharge from hospital and at the 5-week follow-up examination (FU). 31 healthy subjects were tested as controls. RESULTS Significant improvement in DRT was seen for both patient samples (p < 0.05). For patients with a right-side radiculopathy preoperative DRT was 664 ms (median, IQR: 241), which was reduced to 605 ms (median, IQR: 189) immediately postoperatively and to 593 ms (median, IQR: 115) at FU. For patients with a left-side radiculopathy DRT was 675 ms (median, IQR: 247) preoperatively, 638 ms (median, IQR: 242) postoperatively and 619 ms (median, IQR: 162) at FU. Pain was moderately correlated to DRT. Control subjects had a driving reaction time of 487 (median, IQR: 116), which differed significantly from patients at all three testing times (p < 0.001). CONCLUSION Our data indicate a positive effect of the surgery on driving ability. Therefore, we would suggest that for both patient samples it is safe to continue driving after hospital discharge. However, patients have to be informed about increased DRT caused by radiculopathy already before surgery.
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Affiliation(s)
- Martin Thaler
- Department of Orthopaedic Surgery, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria.
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Ostelo R. Answer to the letter to the editor of Carl Hans Fürstenberg et al. (2010) concerning manuscript “transforaminal endoscopic surgery for lumbar stenosis: a systematic review” by Jorm Nellensteijn, Raymond Ostelo, Ronald Bartels, Wilco Peul, Barend Van Royen, Maurits Van Tulder. Eur Spine J 19:879–886. EUROPEAN SPINE JOURNAL 2011. [PMCID: PMC3099158 DOI: 10.1007/s00586-010-1634-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Arts MP, Peul WC. Timing and minimal access surgery for sciatica: a summary of two randomized trials. Acta Neurochir (Wien) 2011; 153:967-74. [PMID: 21365358 PMCID: PMC3076584 DOI: 10.1007/s00701-011-0983-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 02/17/2011] [Indexed: 12/21/2022]
Affiliation(s)
- Mark P. Arts
- Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK The Hague, The Netherlands
| | - Wilco C. Peul
- Department of Neurosurgery, Medical Center Haaglanden, PO Box 432, 2501 CK The Hague, The Netherlands
- Department of Neurosurgery, Leiden University Medical Center, The Hague, The Netherlands
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Kang SH, Park SW. Symptomatic post-discectomy pseudocyst after endoscopic lumbar discectomy. J Korean Neurosurg Soc 2011; 49:31-6. [PMID: 21494360 DOI: 10.3340/jkns.2011.49.1.31] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 11/13/2010] [Accepted: 12/31/2010] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The objectives of this study were to determine the frequency of symptomatic postdiscectomy pseudocyst (PP) after endoscopic discectomy and to compare the results of surgical and conservative management of them. METHODS Initial study participants were 1,503 cases (1,406 patients) receiving endoscopic lumbar discectomy by 23-member board of neurosurgeons from March 2003 to October 2008. All patients' postoperative magnetic resonance imaging (MRI) scans were evaluated. On the postoperative MRI, cystic lesion of T2W high and T1W low at discectomy site was regarded as PP. Reviews of medical records and radiological findings were done. The PP patients were divided into two groups, surgical and conservative management by treatment modality after PP detection. We compared the results of the two groups using the visual analogue scale (VAS) for low back pain (LBP), VAS for leg pain (LP) and the Oswestry disability index (ODI). RESULTS Among 1,503 cases of all male soldiers, the MRIs showed that pseudocysts formed in 15 patients, about 1.0% of the initial cases. The mean postoperative interval from surgery to PP detection was 53.7 days. Interlaminar approach was correlated with PP formation compared with transforaminal approach (p=0.001). The mean VAS for LBP and LP in the surgical group improved from 6.5 and 4.8 to 2.0 and 2.3, respectively. The mean VAS for LBP and LP in the conservative group improved from 4.4 and 4.4 to 3.9 and 2.3, respectively. There was no difference in treatment outcome between surgical and conservative management of symptomatic PP. CONCLUSION Although this study was done in limited environment, symptomatic PP was detected at two months' postoperative period in about 1% of cases. Interlaminar approach seems to be more related with PP compared with transforaminal approach.
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Affiliation(s)
- Suk Hyung Kang
- Department of Neurological Surgery, Yong-San hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Mulholland RC. The Michel Benoist and Robert Mulholland yearly European Spine Journal Review: a survey of the "surgical and research" articles in the European Spine Journal, 2010. 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 2011; 20:163-70. [PMID: 21249508 DOI: 10.1007/s00586-010-1679-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Indexed: 11/29/2022]
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