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Van Isseldyk F, Padilla-Lichtenberger F, Guiroy A, Asghar J, Quillo-Olvera J, Quillo-Reséndiz J, Hagel V. Endoscopic Treatment of Lumbar Degenerative Disc Disease: A Narrative Review of Full-Endoscopic and Unilateral Biportal Endoscopic Spine Surgery. World Neurosurg 2024; 188:e93-e107. [PMID: 38754549 DOI: 10.1016/j.wneu.2024.05.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Accepted: 05/09/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Degenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results. Currently, two different types of endoscopic spine procedures are dominating the surgical scenario: "Full-Endoscopic" (FE) and Unilateral Biportal Endoscopic" (UBE) Spine Surgery. The aim of this study is to describe and analyze their indications, their technical characteristicswithitsadvantagesanddisadvantagesofbothtechniquesandtheirfuture trends. METHODS We performed a narrative review of the most relevant articles published up to August 2023 through a Pub Med search. The search terms " FE Spine Surgery" and " UBE Spine Surgery" were used. The articles selected, were independently reviewed by 3 authors and 55 full text articles were reviewed. RESULTS The FE and UBE Spine Surgery techniques were described. The FE technique is performed with a monoportal access under constant saline irrigation. The FE comprises the transforaminal and the interlaminar approaches, and the indication depends from the pathology to treat, and still remains controversial. UBE can approach also the spine from a posterior, postero lateral,and para spinal route. It uses two different ports addressed to a target with continuous irrigation. The process of establishing these two portals is called triangulation. CONCLUSIONS FE and UBE spine surgery have demonstrated outcomes comparable to open surgery, minimizing complications and surgical footprint.
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Affiliation(s)
- Facundo Van Isseldyk
- Hospital Privado de Rosario, Universidad de Rosario, Rosario City, Santa Fe, Argentina
| | | | - Alfredo Guiroy
- Elite Spine Health and Wellness, Mendoza City, Mendoza, Argentina
| | - Jahangir Asghar
- Elite Spine Health and Wellness, Mendoza City, Mendoza, Argentina
| | - Javier Quillo-Olvera
- Hospital Angeles Centro Sur, Neurosurgery Unit, Spine Center, Queretaro City, Mexico
| | | | - Vincent Hagel
- University Spine Center Zurich, Balgrist University Hospital, University of Zurich, Zurich, Switzerland; Spine Center, Asklepios Hospital Lindau, Lindau, Germany
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Turkkan A, Bekar A, Yigitkanli K. Extraforaminal Microdiscectomy for Upper Lumbar Disc Herniations: A Minimally Invasive Alternative Surgical Approach. World Neurosurg 2024; 188:e540-e545. [PMID: 38815923 DOI: 10.1016/j.wneu.2024.05.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Accepted: 05/22/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Various methods and techniques have been developed for extraforaminal decompression, particularly for far lateral lumbar disc herniation. Distinct anatomical differences are noticeable in the upper levels of the lumbar spine, which may complicate the related surgical approach. This study aimed to determine the safety and efficiency of the far lateral extraforaminal approach for the upper lumbar disc. METHODS L1-2 and L2-3 migrated lumbar disc herniations were defined as upper lumbar disc herniations. 31 consecutive patients with upper lumbar disk herniation who underwent extraforaminal lumbar microdiscectomy between January 2018 and March 2022 were retrospectively investigated. The patients were assessed using the interval history, follow-up lower back and leg pain visual analog scale scores (0-100 mm), the Oswestry Disability Index (%), and modified MacNab criteria. RESULTS 31 consecutive patients with upper lumbar disk herniation (20 men and 11 women) with a mean age of 52.8 ± 10.8 years (range 31-70 years) underwent extraforaminal lumbar microdiscectomy. The preoperative and postoperative visual analog scale scores and Oswestry Disability Index were significantly different (P < 0.001). According to the modified MacNab criteria, 23 patients showed excellent improvement, 5 showed good improvement, and 3 showed fair improvement; thus, the rate of satisfactory improvement was 90.3% at the 2-year follow-up. No patients required reoperation at the operative level during follow-up. CONCLUSIONS Extraforaminal lumbar microdiscectomy is a safe and effective minimally invasive surgical technique for treating upper lumbar disc herniation.
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Affiliation(s)
- Alper Turkkan
- Department of Neurosurgery, Medicana Hospital, Bursa, Turkey
| | - Ahmet Bekar
- Department of Neurosurgery, Bursa Uludag University Faculty of Medicine, Bursa, Turkey
| | - Kazım Yigitkanli
- Department of Neurosurgery, Medicana Hospital, Bursa, Turkey; Department of Neurosurgery, Biruni University Faculty of Medicine, İstanbul, Turkey.
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Yuan S, Mei Y, Zang L, Lu X, Fan N, Du P. Percutaneous transforaminal endoscopic discectomy for Upper Lumbar Disc Herniation versus lower lumbar disc herniation: clinical outcomes and technical consideration. BMC Musculoskelet Disord 2024; 25:470. [PMID: 38879478 PMCID: PMC11179340 DOI: 10.1186/s12891-024-07588-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 06/11/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of patients with ULDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) compared with those with lower LDH. METHODS 60 patients with ULDH or L4-L5 LDH treated with PTED between May 2016 and October 2021. MacNab criteria, visual analog scale (VAS) of back pain and leg pain, and Japanese Orthopedic Association (JOA) were evaluated before and after surgery. RESULTS In the L1-L3 group, 59.1% of the patients had a positive femoral nerve tension test, and 81.8% of the patients had a sensory deficit. Both groups showed significant improvements in VAS scores for low back and leg pain, and JOA scores postoperatively. No significant differences in the degree of improvement were observed between the two groups. The excellent/good rate was 81.8% in the L1-L3 group and 84.2% in the L4-L5 group, showing no significant difference. CONCLUSION PTED has comparable efficacy in treating ULDH as it does in treating lower LDH, it is a safe and effective treatment method for ULDH.
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Affiliation(s)
- Shuo Yuan
- Department of Orthopedics, Capital Medical University, Beijing Chaoyang Hospital, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Yuqi Mei
- Department of Orthopedics, Capital Medical University, Beijing Chaoyang Hospital, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Lei Zang
- Department of Orthopedics, Capital Medical University, Beijing Chaoyang Hospital, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China.
| | - Xuanyu Lu
- Department of Orthopedics, Capital Medical University, Beijing Chaoyang Hospital, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Ning Fan
- Department of Orthopedics, Capital Medical University, Beijing Chaoyang Hospital, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
| | - Peng Du
- Department of Orthopedics, Capital Medical University, Beijing Chaoyang Hospital, 5 JingYuan Road, Shijingshan District, Beijing, 100043, China
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Panebianco CJ, Constant C, Vernengo AJ, Nehrbass D, Gehweiler D, DiStefano TJ, Martin J, Alpert DJ, Chaudhary SB, Hecht AC, Seifert AC, Nicoll SB, Grad S, Zeiter S, Iatridis JC. Combining adhesive and nonadhesive injectable hydrogels for intervertebral disc repair in an ovine discectomy model. JOR Spine 2023; 6:e1293. [PMID: 38156055 PMCID: PMC10751969 DOI: 10.1002/jsp2.1293] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 09/12/2023] [Accepted: 09/20/2023] [Indexed: 12/30/2023] Open
Abstract
Background Intervertebral disc (IVD) disorders (e.g., herniation) directly contribute to back pain, which is a leading cause of global disability. Next-generation treatments for IVD herniation need advanced preclinical testing to evaluate their ability to repair large defects, prevent reherniation, and limit progressive degeneration. This study tested whether experimental, injectable, and nonbioactive biomaterials could slow IVD degeneration in an ovine discectomy model. Methods Ten skeletally mature sheep (4-5.5 years) experienced partial discectomy injury with cruciate-style annulus fibrosus (AF) defects and 0.1 g nucleus pulposus (NP) removal in the L1-L2, L2-L3, and L3-L4 lumbar IVDs. L4-L5 IVDs were Intact controls. IVD injury levels received: (1) no treatment (Injury), (2) poly (ethylene glycol) diacrylate (PEGDA), (3) genipin-crosslinked fibrin (FibGen), (4) carboxymethylcellulose-methylcellulose (C-MC), or (5) C-MC and FibGen (FibGen + C-MC). Animals healed for 12 weeks, then IVDs were assessed using computed tomography (CT), magnetic resonance (MR) imaging, and histopathology. Results All repaired IVDs retained ~90% of their preoperative disc height and showed minor degenerative changes by Pfirrmann grading. All repairs had similar disc height loss and Pfirrmann grade as Injury IVDs. Adhesive AF sealants (i.e., PEGDA and FibGen) did not herniate, although repair caused local endplate (EP) changes and inflammation. NP repair biomaterials (i.e., C-MC) and combination repair (i.e., FibGen + C-MC) exhibited lower levels of degeneration, less EP damage, and less severe inflammation; however, C-MC showed signs of herniation via biomaterial expulsion. Conclusions All repair IVDs were noninferior to Injury IVDs by IVD height loss and Pfirrmann grade. C-MC and FibGen + C-MC IVDs had the best outcomes, and may be appropriate for enhancement with bioactive factors (e.g., cells, growth factors, and miRNAs). Such bioactive factors appear to be necessary to prevent injury-induced IVD degeneration. Application of AF sealants alone (i.e., PEGDA and FibGen) resulted in EP damage and inflammation, particularly for PEGDA IVDs, suggesting further material refinements are needed.
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Affiliation(s)
- Christopher J. Panebianco
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
- Department of Orthopaedic SurgeryUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | | | - Andrea J. Vernengo
- AO Research Institute DavosDavosSwitzerland
- Department of Chemical EngineeringRowan UniversityGlassboroNJUSA
| | | | | | - Tyler J. DiStefano
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Jesse Martin
- Department of Biomedical EngineeringThe City College of New YorkNew YorkNew YorkUSA
| | - David J. Alpert
- Department of Biomedical EngineeringThe City College of New YorkNew YorkNew YorkUSA
| | - Saad B. Chaudhary
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew C. Hecht
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Alan C. Seifert
- Biomedical Engineering and Imaging InstituteIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Steven B. Nicoll
- Department of Biomedical EngineeringThe City College of New YorkNew YorkNew YorkUSA
| | | | | | - James C. Iatridis
- Leni and Peter W. May Department of OrthopaedicsIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
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Chen H, Zhang Z, Bian Z, Hou C, Li M, Zhu L, Wang X. Transforaminal Endoscopic Discectomy for Thoracolumbar Disc Herniation: A Retrospective Study and Technical Note. World Neurosurg 2023; 178:70-77. [PMID: 37454905 DOI: 10.1016/j.wneu.2023.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Thoracolumbar disc herniation (TLDH) is a rare disorder with unique characteristics that can result in undesirable surgical outcomes after traditional discectomy. In view of the widespread use of transforaminal endoscopic discectomy for lower lumbar disc herniation, we investigated treatment of TLDH by this procedure. The purpose of this study was to evaluate the clinical efficacy of transforaminal endoscopic discectomy for treating TLDH and share our technical experience. METHODS We retrospectively evaluated the clinical data of 19 patients who had undergone transforaminal endoscopic discectomy for TLDH in our institution between April 2018 and July 2021. Operation time, follow-up time, blood loss, postoperative hospital stay, visual analog scale scores for low-back and leg pain, and Japanese Orthopedic Association (JOA) scores were evaluated. RESULTS The differences between preoperative and postoperative JOA and visual analog scale scores were significant (P < 0.05). According to the JOA scores, 14 of the 19 patients had excellent improvement, 3 had good improvement, and 2 had fair improvement; thus, the rate of satisfactory improvement was 89.5%. CONCLUSIONS Operation time, blood loss, postoperative hospital stay, and surgical outcomes were favorable. Transforaminal endoscopic discectomy is an ideal surgical procedure for treating TLDH.
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Affiliation(s)
- Hao Chen
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhen Zhang
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhenyu Bian
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Changju Hou
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Maoqiang Li
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Liulong Zhu
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xuepeng Wang
- Department of Orthopedic Surgery, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China.
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Bajaj AI, Yap N, Derman PB, Konakondla S, Kashlan ON, Telfeian AE, Hofstetter CP. Comparative analysis of perioperative characteristics and early outcomes in transforaminal endoscopic lumbar diskectomy: general anesthesia versus conscious sedation. 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 2023:10.1007/s00586-023-07792-4. [PMID: 37450041 DOI: 10.1007/s00586-023-07792-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/18/2023] [Accepted: 05/21/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE To better understand how anesthesia type impacts patient selection and recovery in TELD, we conducted a multicenter prospective study which evaluates the differences in perioperative characteristics and outcomes between patients who underwent TELD with either general anesthesia (GA) or conscious sedation (CS). METHODS We prospectively collected data from all TELD performed by five neurosurgeons at five different medical centers between February and October of 2022. The study population was dichotomized by anesthesia scheme, creating CS and GA cohorts. This study's primary outcomes were the Oswetry Disability Index (ODI) and the Visual Analog Scale (VAS) for back and leg pain, assessed preoperatively and at 2-week follow-up. RESULTS A total of 52 patients underwent TELD for symptomatic lumbar disk herniation. Twenty-three patients received conscious sedation with local anesthesia, and 29 patients were operated on under general anesthesia. Patients who received CS were significantly older (60.0 vs. 46.7, p < 0.001) and had lower BMI (28.2 vs. 33.4, p = 0.005) than patients under GA. No intraoperative or anesthetic complications occurred in the CS and GA cohorts. Improvement at 2-week follow-up in ODI, VAS-back, and VAS-leg was greater in patients receiving CS relative to patients under GA, but these differences were not statistically significant. CONCLUSION In our multicenter prospective analysis of 52 patients undergoing TELD, we found that patients receiving CS were significantly older and had significantly lower BMI compared to patients under GA. On subgroup analysis, no statistically significant differences were found in the improvement of PROMs between patients in the CS and GA group.
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Affiliation(s)
- Ankush I Bajaj
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Natalie Yap
- Department of Neurological Surgery, University of Washington, Seattle, WA, USA
| | - Peter B Derman
- Texas Back Institute, 6020 West Parker Rd, Plano, TX, 75093, USA
| | - Sanjay Konakondla
- Department of Neurosurgery, Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA, 17822, USA
| | - Osama N Kashlan
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Albert E Telfeian
- Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA
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Mooney J, Laskay N, Erickson N, Salehani A, Mahavadi A, Ilyas A, Mainali B, Nowak B, Godzik J. General vs Local Anesthesia for Percutaneous Endoscopic Lumbar Discectomy (PELD): A Systematic Review and Meta-Analysis. Global Spine J 2023; 13:1671-1688. [PMID: 36564907 PMCID: PMC10448082 DOI: 10.1177/21925682221147868] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES It remains unknown whether general anesthesia (GA) or local ± epidural anesthesia (LA) results in superior outcomes with percutaneous endoscopic lumbar discectomy (PELD). The present study sought to examine the impact of anesthesia type on patient-reported outcomes (PROs) and complications with PELD. METHODS Systematic review and meta-analysis examining PELD performed under GA or LA was conducted. Patient-reported outcomes including Visual Analog Scale (VAS)-leg/back, and Oswestry Disability Index (ODI) scores were collected. Complication, recurrent disc herniation, durotomy, and reoperation rates as well as surgical data were recorded. All outcomes were compared between pooled studies examining GA or LA. RESULTS Sixty-eight studies consisting of 5269 patients (724 GA, 4465 LA) were included in the meta-analysis. Overall complication rate was significantly higher in the GA group (9% vs 4%, P = .003). Durotomy rates, length of stay, recurrent disc herniation and reoperation rates were similar between groups. At the first follow-up timepoint, the LA group demonstrated significant improvements in VAS back and ODI scores (P < .05) while the GA group did not (P > .05). At the final follow-up (> 6 months), the percent of patients achieving an excellent McNab score was significantly higher in the GA vs LA group (P < .001). CONCLUSIONS Percutaneous endoscopic lumbar discectomy with LA may be associated with greater short-term improvement in VAS back pain and ODI scores. General anesthesia may be associated with more durable pain relief but a higher complication rate. Further systematic investigation is necessary to determine what short and long term benefits are associated with PELD performed under LA and GA.
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Affiliation(s)
- James Mooney
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas Laskay
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicholas Erickson
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Arsalaan Salehani
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Anil Mahavadi
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bipul Mainali
- School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Błażej Nowak
- Department of Neurosurgery, John Paul II Western Hospital, Grodzisk Mazowiecki, Poland
| | - Jake Godzik
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, AL, USA
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Kotheeranurak V, Liawrungrueang W, Quillo-Olvera J, Siepe CJ, Li ZZ, Lokhande PV, Choi G, Ahn Y, Chen CM, Choi KC, Van Isseldyk F, Hagel V, Koichi S, Hofstetter CP, Del Curto D, Zhou Y, Bolai C, Bae JS, Assous M, Lin GX, Jitpakdee K, Liu Y, Kim JS. Full-Endoscopic Lumbar Discectomy Approach Selection: A Systematic Review and Proposed Algorithm. Spine (Phila Pa 1976) 2023; 48:534-544. [PMID: 36745468 DOI: 10.1097/brs.0000000000004589] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/28/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN A systematic review of the literature to develop an algorithm formulated by key opinion leaders. OBJECTIVE This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. SUMMARY OF BACKGROUND DATA Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. MATERIALS AND METHODS A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). RESULTS In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. CONCLUSIONS The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.
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Affiliation(s)
- Vit Kotheeranurak
- Department of Orthopedics, Faculty of Medicine, Chulalongkorn University, and King Chulalongkorn Memorial Hospital, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | | | - Javier Quillo-Olvera
- Department of Neurosurgery, The Brain and Spine Care, Minimally Invasive Spine Surgery Group, Spine Center, Hospital H+, Queretaro City, Mexico
| | - Christoph J Siepe
- Schön Clinic Munich Harlaching, Munich, Germany
- Paracelsus Medical University (PMU), Salzburg, Austria
| | - Zhen Zhou Li
- The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Gun Choi
- Wooridul Spine Hospital, Pohang, South Korea
| | - Yong Ahn
- Gachon University, Incheon, South Korea
| | | | | | | | - Vincent Hagel
- University Spine Center Zürich, Balgrist University Hospital, Zürich, Switzerland
| | - Sairyo Koichi
- Tokushima University Graduate School, Kuramoto, Tokushima, Japan
| | | | - David Del Curto
- School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Yue Zhou
- Xinquiao Hospital, Third Military Medical University, Chongquing, China
| | - Chen Bolai
- Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Jun Seok Bae
- Wooridul Spine Hospital, Gangnam-Gu Seoul, Korea
| | - Muhammed Assous
- Razi Spine Clinic-Minimally Invasive Spine Surgery, Amman, Jordan
| | - Guang-Xun Lin
- Department of Orthopedics, The First Affiliated Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- The Third Clinical Medical College, Fujian Medical University, Fuzhou, Fujian, China
| | - Khanathip Jitpakdee
- Orthopedic Department, Queen Savang Vadhana Memorial Hospital. Sriracha, Chonburi, Thailand
| | - Yanting Liu
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea
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Jitpakdee K, Liu Y, Kim YJ, Kotheeranurak V, Kim JS. Factors associated with incomplete clinical improvement in patients undergoing transforaminal endoscopic lumbar discectomy for lumbar disc 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 2023:10.1007/s00586-023-07636-1. [PMID: 36917301 DOI: 10.1007/s00586-023-07636-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 11/22/2022] [Accepted: 03/04/2023] [Indexed: 03/16/2023]
Abstract
PURPOSES To analyze the clinical and radiographic risk factors that might predict incomplete clinical improvement after transforaminal endoscopic lumbar discectomy (TELD). METHODS A retrospective analysis was conducted from 194 consecutive patients who underwent TELD due to lumbar disc herniation (LDH). Patients with incomplete clinical improvement were defined from patient-reported outcomes of poor improvement in pain or disability after surgery and patient dissatisfaction. Clinical and radiographic characteristics were evaluated to identify predicting factors of poor outcomes. RESULTS Of 194 patients who underwent TELD procedures, 32 patients (16.5%) had incomplete clinical improvement and 12 patients (6.1%) required revision surgery. The mean ages were 46.4 years and most of the patients suffered from predominant leg pain (48.9%). The most common surgical level was L4-5 (63.9%). Overall, the Oswestry Disability Index (44.3-15), visual analog scores of back pain (4.9-1.8) and leg pain (7.3-1.6) were significantly improved after surgery. Multivariate logistic regression analysis demonstrated that high body mass index, history of previous surgery, preoperative disability, weakness, and disc degeneration were related to incomplete clinical improvement. There were 15 recurrent LDH (7.7%) with a total of 12 revision surgeries (6.2%). CONCLUSIONS We identified independent risk factors associated with incomplete clinical improvement following TELD, including overweight, significant preoperative disability or weakness and history of previous surgery. Advanced age, disc degeneration, vacuum phenomenon, and spondylolisthesis were also possible risk factors. Recognizing these risk factors would help decide whether patients are good candidates for TELD, and optimize the surgical planning preoperatively to achieve good surgical results.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopaedics, Queen Savang Vadhana Memorial Hospital, Thai Red Cross Society, Chonburi, Thailand
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yanting Liu
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Young-Jin Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Center of Excellence in Biomechanics and Innovative Spine Surgery, Chulalongkorn University, Bangkok, Thailand
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Meng S, Han J, Xu D, Wang Y, Han S, Zhu K, Lin A, Su K, Li Y, Han X, Ma X, Zhou C. Fully endoscopic transforaminal discectomy for thoracolumbar junction disc herniation with or without calcification under general anesthesia: Technical notes and preliminary outcomes. Front Surg 2023; 9:1067775. [PMID: 36684323 PMCID: PMC9852773 DOI: 10.3389/fsurg.2022.1067775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/21/2022] [Indexed: 01/09/2023] Open
Abstract
Objective To evaluate the feasibility, safety, and outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for thoracolumbar junction disc herniation (TLDH) with or without calcification. Methods This study included 12 patients diagnosed with TLDH with or without calcification who met the inclusion criteria and underwent surgery for PETD from January 2019 to December 2021. The mean patient age, operation time, hospitalization time, time in bed, and complications were recorded. Patients were followed up for at least 9 months. Visual analog scale (VAS) scores for low-back and leg or thoracic radicular pain and modified Japanese Orthopedic Association score (m-JOA) scores were preoperatively evaluated, at 1 day and 3, 6, and 12 months postoperatively or at last follow-up. The modified MacNab criteria were used to evaluate clinical efficacy at 12 months postoperatively or at last follow-up. Results The mean patient age, operation time, hospitalization time, and time in bed were 53 ± 13.9 years, 101.3 ± 9.2 min, 4.5 ± 1.3 days, and 18.0 ± 7.0 h, respectively. The mean VAS scores of low-back and leg or thoracic radicular pain improved from 5.8 ± 1.5 and 6.5 ± 1.4 to 2.0 ± 0.9 and 1.3 ± 0.5, respectively (P < 0.05). The m-JOA score improved from 7.5 ± 1.2 to 10.0 ± 0.7 (P < 0.05). The overall excellent-good rate of the modified MacNab criteria was 83.3%. No severe complications occurred. Conclusion Fully endoscopic transforaminal discectomy and ventral decompression under general anesthesia is a safe, feasible, effective, and minimally invasive method for treating herniated discs with or without calcification at thoracolumbar junction zone.
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Affiliation(s)
- Shengwei Meng
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Jialuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Derong Xu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yan Wang
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shuo Han
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kai Zhu
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Antao Lin
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Kunpeng Su
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yaxiong Li
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xing Han
- Operating Room, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuexiao Ma
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuanli Zhou Xuexiao Ma
| | - Chuanli Zhou
- Department of Spinal Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China,Correspondence: Chuanli Zhou Xuexiao Ma
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11
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Kapetanakis S, Gkantsinikoudis N, Apostolakis S. Technical challenges and surgical outcomes of percutaneous transforaminal endoscopic discectomy in patients with upper lumbar disc herniation: a prospective clinical study. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04725-6. [PMID: 36543922 DOI: 10.1007/s00402-022-04725-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Upper lumbar disc herniation (ULDH) constitutes a considerably complex and rare anatomic entity. As such, there are only a handful of studies investigating the application of percutaneous transforaminal endoscopic discectomy (PTED) in the management of this cause of low back pain. RESEARCH QUESTION To elucidate the safety and effectiveness of PTED in patients with ULDH. MATERIALS AND METHODS Twenty-six (26) individuals with diagnosed ULDH (L1-L2, L2-L3) according to clinical and radiologic criteria were prospectively evaluated in a 2-year follow-up period. All patients were assessed preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively. Clinical evaluation was conducted with visual analogue scale for lower limb (VAS-LP) and low back (VAS-BP) pain in conjunction with Short-Form 36 (SF-36) Medical Health Survey Questionnaire. Potential complications were recorded in each follow-up interval. RESULTS One patient (3.8%) featured temporary postoperative dysesthesia that was completely resolved at 6 weeks. No other major perioperative complications were observed. Values of all studied indices were found to be statistically significantly ameliorated at the end of follow-up. Improvement was depicted to be quantitatively maximal at 6 weeks postoperatively. CONCLUSIONS PTED constitutes a safe and effective technique for surgical management of ULDH that merits further assessment in current clinical practice in the framework of multicenter randomized controlled trials. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece. .,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, 15125, Athens, Greece.
| | - Nikolaos Gkantsinikoudis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece
| | - Sotirios Apostolakis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece
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12
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Fukuhara D, Ono K, Kenji T, Majima T. A Narrative Review of Full-Endoscopic Lumbar Discectomy Using Interlaminar Approach. World Neurosurg 2022; 168:324-332. [DOI: 10.1016/j.wneu.2022.08.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 12/14/2022]
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13
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Xu W, Yang B, Lai X, Hong X, Chen Z, Yu D. Comparison of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for upper lumbar disc herniation: A protocol for a systematic review and meta-analysis. Medicine (Baltimore) 2021; 100:e27914. [PMID: 34797347 PMCID: PMC8601282 DOI: 10.1097/md.0000000000027914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED), as two alternative surgical techniques in minimally invasive spine surgery (MISS), are widely conducted in the treatment of upper lumbar disc herniation (ULDH). This study will systematically assess and compare the clinical outcomes of MED and PTED in treating ULDH combining with the meta-analysis. METHODS All the randomized controlled trials (RCTs) will be searched at the databases including PubMed, EMBASE, Cochrane Library and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and WANFANG Database from inception to December 2025. The primary outcome will involve Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and visual analog scale (VAS) scores. The secondary outcomes will be the short-form 36-item (SF-36) health survey questionnaire and the modified MacNab criterion. We will perform data synthesis, subgroup analysis, sensitivity analysis, meta-regression analysis, and the assessment of reporting bias using RevMan 5.3 software. RESULTS This systematic review will comprehensively evaluate the clinical outcomes of comparison of MED and PTED in the treatment of ULDH and provide a reliable and high-quality evidence. CONCLUSION The conclusion of this study will elucidate the clinical outcomes of MED compared with PTED and clarify whether PTED generates better clinical effects than MED in treating ULDH. PROSPERO REGISTRATION NUMBER CRD 42021244204.
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Affiliation(s)
- WeiJun Xu
- Guangdong Chaozhou Health Vocational College, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong, China
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Bingxuan Yang
- Guangdong Chaozhou Health Vocational College, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong, China
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Third Clinical Medical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xidan Lai
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Master Degree Application of Equivalent Educational Level of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xinxin Hong
- Department of Graduate School, Guangzhou University of Chinese Medicine, Guangzhou, China
- The Fourth Clinical Medical College of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Zihao Chen
- Department of Orthopedics, Traditional Chinese Medical Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China
| | - Dongqing Yu
- Guangdong Chaozhou Health Vocational College, The Second Clinical Medical College of Guangzhou University of Chinese Medicine, Guangdong, China
- Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
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14
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Ahn Y, Yoo BR, Jung JM. The irony of the transforaminal approach: A comparative cohort study of transforaminal endoscopic lumbar discectomy for foraminal versus paramedian lumbar disc herniation. Medicine (Baltimore) 2021; 100:e27412. [PMID: 34622848 PMCID: PMC8500638 DOI: 10.1097/md.0000000000027412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/17/2021] [Indexed: 01/05/2023] Open
Abstract
Transforaminal endoscopic lumbar discectomy (TELD) is useful for soft lumbar disc herniation (LDH). Although the transforaminal approach can reach the foraminal disc zone, the risk of exiting nerve root irritation along the path is considerable. Few studies have assessed the difficulties of TELD for foraminal LDH. The objective of this study is to compare the clinical results of TELD between foraminal or far-lateral LDH and paramedian LDH.Between June 2016 and July 2017, 135 consecutive patients with single-level LDH were treated with TELD for 2 years. Among them, 25 patients had foraminal or far-lateral LDH (foraminal group), and the remaining 110 patients had central or subarticular LDH (paramedian group). Perioperative data and clinical outcomes were evaluated using the visual analog pain scale, Oswestry Disability Index, and modified Macnab criteria.The foraminal group showed a higher rate of significant access pain (24.00% vs 8.19%, P < .05). The foraminal group also had a longer duration of surgery, length of hospital stay, and return to work (all P < .05). Pain scores and functional status were significantly improved in both groups. Although there were no differences in the outcomes at 2 years postoperatively, early pain and disability at 6 weeks were higher in the foraminal group.Ironically, the early clinical results of TELD for foraminal LDH may be less favorable than those for paramedian LDH. Therefore, great care should be taken during TELD for foraminal or far-lateral LDH.
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15
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Zhou Z, Ni HJ, Hu S, Fan YS, Wang CF, Chen X, Zhu YJ, Li G, Liu F, Feng CB, He SS. Original Designed Uniportal-Bichannel Spinal Endoscopic System (UBiSES) for Foraminoplasty in Percutaneous Endoscopic Transforaminal Discectomy. Orthop Surg 2021; 13:1987-1999. [PMID: 34523790 PMCID: PMC8528981 DOI: 10.1111/os.13050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/19/2021] [Accepted: 04/17/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE The study introduced uniportal-bichannel spinal endoscopic system (UBiSES) and explored the feasibility of applying UBiSES to conduct lumbar foraminoplasty in percutaneous endoscopic transforaminal discectomy (PETD). METHODS This is a cohort study. 36 patients confirmed as L5/S1 lumbar disc herniation (LDH) in our hospital from March, 2019 to November, 2019 were enrolled. 36 patients were divided into two groups named the UBiSES group (n = 18, male: female = 8:10) and the TESSYS group (n = 18, male: female = 10:8). The average age of the UBiSES group and the TESSYS group were 40.94 ± 12.39 years old and 39.78 ± 13.02 years old respectively. PETD via uniportal-bichannel foraminoplasty assisted by UBiSES was adopted on the UBiSES group while PETD via conventional foraminoplasty was performed on the TESSYS group. One experienced surgeon with more than 4000 cases of lumbar surgery performed PETD on all patients. The demographic data, the duration of working cannula placement (minutes), decompression time (minutes), radiation exposure time (seconds), complications, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) scores and modified MacNab criteria were recorded and analyzed. The magnetic resonance imaging (MRI) and computed tomography (CT) were conducted to evaluate the radiographic improvement. RESULTS PETD via lumbar foraminoplasty was successfully performed in all cases. The follow-up points were 3 months, 6 months, and 12 months. The average follow-up period of all patients was 15.78 ± 2.29 months. There was no statistic difference in age (P = 0.81), sex (P = 0.51) and follow-up (P = 0.14) between two groups. The duration of working cannula placement was 19.08 ± 2.30 min in the UBiSES group and 24.90 ± 4.71 min in the TESSYS group and there was significant difference between two groups (P < 0.05). There was no statistic difference in decompression time between the UBiSES group (44.18 ± 5.70 min) and the TESSYS group (47.46 ± 5.96 min) (P = 1.70). The radiation exposure time was 28.00 ± 4.70 s in the UBiSES group and 40.50 ± 5.73 s in the TESSYS group respectively, and has significant difference between two groups (P < 0.05). Furthermore, there was significant different in the duration of working cannula placement and radiation exposure time in male or female between the UBiSES group and the TESSYS group (P < 0.05). For male or female, no difference observed in decompression time and follow-up period between two groups. Postoperative VAS of low back and leg at every follow-up point (1 day, 3 months, 6 months, 12 months) was improved significantly in both groups compared with their preoperative VAS (P < 0.05). The postoperative ODI (3 months, 6 months, 12 months) has decreased significantly in both the UBiSES group and the TESSYS group compared with their preoperative ODI (P < 0.05). 94.44% patients received an excellent or good recovery in the UBiSES group and 88.89% for the TESSYS group. There was no poor result reported in both groups. The radiographic images showed satisfactory foraminoplasty and sufficient decompression of nerve in both groups. No postoperative complications were observed during follow-ups in the UBiSES group. Two patients in the TESSYS group experienced postoperative dysesthesia and the symptom was disappeared in 5 days and 7 days respectively with dexamethasone and neurotrophic drugs treatment. CONCLUSIONS The original designed UBiSES could effectively and safely enlarge the foramen with an extensive surgical view and space under full-time and real-time visualization and get satisfactory efficacy.
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Affiliation(s)
- Zhi Zhou
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Hai-Jian Ni
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shuo Hu
- Orthopaedics Department, Shanghai General Hospital, Shanghai Jiao Tong University, School of Medicine, Shanghai, China
| | - Yun-Shan Fan
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Chuan-Feng Wang
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xin Chen
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Yan-Jie Zhu
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Gang Li
- Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Fei Liu
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chao-Bo Feng
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
| | - Shi-Sheng He
- Orthopaedics Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.,Spinal Pain Research Institute, Tongji University School of Medicine, Shanghai, China
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16
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Hasan S, White-Dzuro B, Barber JK, Wagner R, Hofstetter CP. The Endoscopic Trans-Superior Articular Process Approach: A Novel Minimally Invasive Surgical Corridor to the Lateral Recess. Oper Neurosurg (Hagerstown) 2021; 19:E1-E10. [PMID: 32281629 DOI: 10.1093/ons/opaa054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/01/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Transforaminal approaches to the lumbar spine are typically performed utilizing Kambin's triangle as approach corridor; however, degenerative changes can distort anatomy and expose the exiting nerve root to inadvertent injury. OBJECTIVE To describe the surgical technique of a novel full-endoscopic approach to access the lateral recess and report clinical outcomes. METHODS The trans-superior articular process (SAP) approach involves partial resection of the SAP, allowing access to the lateral recess both ventral and dorsal to the traversing nerve root. A retrospective review of 40 patients who had undergone a trans-SAP approach for decompression of lateral recess pathology was conducted. Outcomes were measured using visual analog scores (VAS) and Oswestry Disability Index (ODI) at 2 wk, 3 mo, and at last follow-up. RESULTS At a mean follow-up of 24 mo, patients experienced statistically significant improvement of the VAS for ipsilateral leg pain, VAS for back pain, and ODI when comparing preoperative values to all postoperative time points. The percentage of patients reaching a minimally clinically important difference for VAS leg pain and ODI was approximately 90% and 88%, respectively. The complication profile was favorable with no dural tears and no postoperative motor or sensory deficits. One patient required revision, with a total reoperation rate of 3%. CONCLUSION The trans-SAP approach is a novel approach that utilizes a safe surgical corridor via the SAP to access lateral recess pathology. Our initial clinical experience suggests that the trans-SAP approach allows for treatment of lateral recess and foraminal pathology with low complication rates.
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Affiliation(s)
- Saqib Hasan
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
| | - Brie White-Dzuro
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
| | - Jason K Barber
- Department of Neurological Surgery, The University of Washington, Seattle, Washington
| | - Ralf Wagner
- Ligamenta Spine Center, Frankfurt am Main, Germany
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17
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Erdoğan U. The Results of Using a Transforaminal Lumbar Interbody Fusion Cage at the Upper Lumbar Level. Cureus 2021; 13:e15496. [PMID: 34268027 PMCID: PMC8262652 DOI: 10.7759/cureus.15496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 12/04/2022] Open
Abstract
Aim The aim of this study is to apply surgical treatments to upper lumbar disc hernias in order to provide lumbar stability and lumbar lordosis using a transforaminal lumbar interbody fusion (TLIF) cage and to preserve the success rate of surgical results by protecting neural structures without excessive subject tension. Material and methods Between 2012 and 2017, 32 patients who had undergone an operation for upper lumbar disc herniation and who had received a transforaminal lumbar interbody fusion cage using a posterior technique were evaluated retrospectively. Results The radiological and clinical findings, surgical methods, and results of the patients were evaluated. In our study, 25 (78.1%) of the patients with upper lumbar disc hernias who were evaluated retrospectively were female and seven (21.9%) were male. Their average age was 55.43 years. The average follow-up was 21.75 months. The most common complaints were lower back pain, leg pain, and claudication. In the findings from neurological examinations, a positive result on the femoral stretching test occurred in 30 (93.7%) patients. In the degenerative spinal structure of patients at the L1-2 and L2-3 levels, a transforaminal lumbar interbody fusion was performed via a wide laminectomy with posterior stabilization due to a wide-bottomed disc hernia and stenosis. Only one of the patients with a neurological deficit still had a motor deficit after surgery. Conclusion While planning a surgery for upper lumbar disc hernias, the anatomical features of this region and the patients' radiological and neurological findings should be carefully evaluated. If TLIF is performed during upper lumbar region surgery, it may be preferable to perform it using a posterior technique.
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Affiliation(s)
- Uzay Erdoğan
- Neurosurgery, University of Health Sciences, Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Neurology, Neurosurgery and Psychiatry, Istanbul, TUR
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18
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Echt M, Holland R, Mowrey W, Cezayirli P, Ramos RDLG, Hamad M, Gelfand Y, Longo M, Kinon MD, Yanamadala V, Chaudhary S, Cho SK, Yassari R. Surgical Outcomes for Upper Lumbar Disc Herniations: A Systematic Review and Meta-analysis. Global Spine J 2021; 11:802-813. [PMID: 32744112 PMCID: PMC8165931 DOI: 10.1177/2192568220941815] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE To conduct a literature review on outcomes of discectomy for upper lumbar disc herniations (ULDH), estimate pooled rates of satisfactory outcomes, compare open laminectomy/microdiscectomy (OLM) versus minimally invasive surgical (MIS) techniques, and compare results of disc herniations at L1-3 versus L3-4. METHODS A systematic review of articles reporting outcomes of nonfusion surgical treatment of L1-2, L2-3, and/or L3-4 disc herniations was performed. The inclusion and exclusion of studies was performed according to the latest version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. RESULTS A total of 20 articles were included in the quantitative meta-analysis. Pooled proportion of satisfactory outcome (95% CI) was 0.77 (0.70, 0.83) for MIS and 0.82 (0.78, 0.84) for OLM. There was no significant improvement with MIS techniques compared with standard OLM, odds ratio (OR) = 0.86, 95% CI (0.42, 1.74), P = .66. Separating results by levels revealed a trend of higher satisfaction with L3-4 versus L1-3 with OLM surgery, OR = 0.46, 95% CI (0.19, 1.12), P = .08. CONCLUSION Our analysis reveals that discectomy for ULDH has an overall success rate of approximately 80% and has not improved with MIS. Discectomy for herniations at L3-4 trends toward better outcomes compared with L1-2 and L2-3, but was not significant.
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Affiliation(s)
- Murray Echt
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
,Icahn School of Medicine at Mount Sinai, New York, NY, USA,Murray Echt, Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, 439 Calhoun Avenue, Bronx, NY 10467, USA.
| | - Ryan Holland
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Wenzhu Mowrey
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Phillip Cezayirli
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Mousa Hamad
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Yaroslav Gelfand
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael Longo
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Merritt D. Kinon
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Vijay Yanamadala
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Saad Chaudhary
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Reza Yassari
- Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
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19
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Tong Y, Huang Z, Fan Z, Zhao C, Song Y. Successful treatment of continuous ossification of the posterior longitudinal ligament in the lumbar spine using percutaneous transforaminal endoscopic spinal decompression: a case report. J Int Med Res 2021; 49:3000605211004774. [PMID: 33823635 PMCID: PMC8033471 DOI: 10.1177/03000605211004774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Ossification of the posterior longitudinal ligament (OPLL) of the lumbar spine is rare relative to that of the cervical spine but is often associated with more severe symptoms. Continuous lumbar OPLL is extremely rare. We herein describe a 48-year-old Chinese woman with lumbar spinal stenosis caused by continuous OPLL. She presented with a 5-year history of lower back pain and intermittent claudication. We performed percutaneous transforaminal endoscopic decompression by the posterolateral approach to achieve adequate decompression of the spinal canal up to the lower 1/3 level (0.9 cm) of the L1 vertebral body and down to the upper 1/2 level (1.3 cm) of the L2 vertebral body. After surgery, the patient's neurological function substantially improved, and her visual analog scale scores for the lower back and both lower extremities and her Oswestry disability index were significantly lower than those in the preoperative period. During the 12-month clinical follow-up period, the patient's neurological function was fully restored, and she regained her ability to walk normally. No surgery-related complications were observed. This case report describes a novel surgical approach that may be an effective treatment alternative for continuous lumbar OPLL.
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Affiliation(s)
- Yuexin Tong
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.,Graduate School, Chengde Medical University, Chengde, Hebei, China
| | - Zhangheng Huang
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.,Graduate School, Chengde Medical University, Chengde, Hebei, China
| | - Zhiyi Fan
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China.,Graduate School, Chengde Medical University, Chengde, Hebei, China
| | - Chengliang Zhao
- Department of Orthopedic, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Youxin Song
- Department of Orthopedic, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
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20
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Bai X, Lian Y, Wang J, Zhang H, Jiang M, Zhang H, Pei B, Hu C, Yang Q. Percutaneous endoscopic lumbar discectomy compared with other surgeries for lumbar disc herniation: A meta-analysis. Medicine (Baltimore) 2021; 100:e24747. [PMID: 33655938 PMCID: PMC7939231 DOI: 10.1097/md.0000000000024747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 01/16/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This meta-analysis was performed to investigate whether percutaneous endoscopic lumbar discectomy (PELD) had a superior effect than other surgeries in the treatment of patients with lumbar disc herniation (LDH). METHOD We searched PubMed, Embase, and Web of Science through February 2018 to identify eligible studies that compared the effects and complications between PELD and other surgical interventions in LDH. The outcomes included success rate, recurrence rate, complication rate, operation time, hospital stay, blood loss, visual analog scale (VAS) score for back pain and leg pain, 12-item Short Form Health Survey (SF12) physical component score, mental component score, Japanese Orthopaedic Association Score, Oswestry Disability Index. A random-effects or fixed-effects model was used to pool the estimate, according to the heterogeneity among the included studies. RESULTS Fourteen studies (involving 2,528 patients) were included in this meta-analysis. Compared with other surgeries, PELD had favorable clinical outcomes for LDH, including shorter operation time (weight mean difference, WMD=-18.14 minutes, 95%CI: -25.24, -11.05; P < .001) and hospital stay (WMD = -2.59 days, 95%CI: -3.87, -1.31; P < .001), less blood loss (WMD = -30.14 ml, 95%CI: -43.16, -17.13; P < .001), and improved SF12- mental component score (WMD = 2.28, 95%CI: 0.50, 4.06; P = .012)) and SF12- physical component score (WMD = 1.04, 95%CI: 0.37, 1.71; P = .02). However, it also was associated with a significantly higher rate of recurrent disc herniation (relative risk [RR] = 1.65, 95%CI: 1.08, 2.52; P = .021). There were no significant differences between the PELD group and other surgical group in terms of success rate (RR = 1.01, 95%CI: 0.97, 1.04; P = .733), complication rate (RR = 0.86, 95%CI: 0.63, 1.18; P = .361), Japanese Orthopaedic Association Score score (WMD = 0.19, 95%CI: -1.90, 2.27; P = .861), visual analog scale score for back pain (WMD = -0.17, 95%CI: -0.55, 0.21; P = .384) and leg pain (WMD = 0.00, 95%CI: -0.10, 0.10; P = .991), and Oswestry Disability Index score (WMD = -0.29, 95%CI: -1.00, 0.43; P = .434). CONCLUSION PELD was associated with better effects and similar complications with other surgeries in LDH. However, it also resulted in a higher recurrence rate. Considering the potential limitations in the present study, further large-scale, well-performed randomized trials are needed to verify our findings.
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Affiliation(s)
- Xiaoliang Bai
- Department of Spine Surgery, Tianjin Hospital, Tianjin
- Department of NO.5 orthopaedics, Baoding NO.1 Central Hospital
| | - Yong Lian
- Department of NO.5 orthopaedics, Baoding NO.1 Central Hospital
| | - Jie Wang
- Department of NO.5 orthopaedics, Baoding NO.1 Central Hospital
| | - Hongxin Zhang
- Department of NO.5 orthopaedics, Baoding NO.1 Central Hospital
| | - Meichao Jiang
- Department of NO.5 orthopaedics, Baoding NO.1 Central Hospital
| | - Hao Zhang
- Department of orthopaedics, The NO.2 hospital of Baoding, Baoding, Hebei, China
| | - Bo Pei
- Department of NO.5 orthopaedics, Baoding NO.1 Central Hospital
| | - Changqing Hu
- Department of NO.5 orthopaedics, Baoding NO.1 Central Hospital
| | - Qiang Yang
- Department of Spine Surgery, Tianjin Hospital, Tianjin
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Hu Y, Zheng Y, Chen G, Chen W. Comparison of percutaneous endoscopic discectomy and microendoscopic discectomy in treatment of symptomatic lumbar disc herniation: A protocol of cohort study. Medicine (Baltimore) 2020; 99:e22709. [PMID: 33080722 PMCID: PMC7572032 DOI: 10.1097/md.0000000000022709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite some researchers have compared the safety and effectiveness of percutaneous endoscopic discectomy (PED) and microendoscopic discectomy (MD) for the lumbar disc herniation; however, they got conflicting outcomes in several variables. Therefore, our aim was to clarify whether PED produces less surgical trauma and better clinical results than MD. METHODS A single-center, retrospective cohort trial was conducted for the comparison of the safety and effectiveness between the MD and PED in the patients with lumbar disc herniation who received surgery from May 2016 to July 2018 in our hospital. The inclusion criteria for our investigation included:The follow-ups were performed 6 weeks, 3, 6, 12 and 24 months after the surgery. Numeric Rating Scale, Short-form 36, and Oswestry Disability Index, as well as complications were evaluated in our study. The software of SPSS Version 22.0 (IBM Corporation, Armonk, NY) was applied to analyze all the statistical data. When P is less than .05, the difference is significant in statistics. RESULTS This protocol will provide a solid theoretical basis for exploring which technique is better in treatment of lumbar disc herniation. TRIAL REGISTRATION This protocol was registered in Research Registry (researchregistry6005).
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Affiliation(s)
- Yabin Hu
- Department of Orthopedics, The Second Hospital of Nanjing, Jiangsu
| | - Yong Zheng
- Department of Bone injury, Shaanxi Hospital of Traditional Chinese Medicine, Shaanxi
| | - Guangfu Chen
- Department of Anesthesiology, Fuzhou Second Hospital Affiliated to Xiamen University, Fujian
| | - Wei Chen
- Department of Spine Surgery, Fuzhou Second Hospital Affiliated to Xiamen University, Fujian, China
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Budisulistyo T, Atmaja F. Percutaneous Discectomy Followed by CESI Might Improve Neurological Disorder of Drop Foot Patients Due to Chronic LDH. Brain Sci 2020; 10:brainsci10080539. [PMID: 32796497 PMCID: PMC7465042 DOI: 10.3390/brainsci10080539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/23/2023] Open
Abstract
(1) Introduction: Epiconus and conus medullary syndromes that consisted of drop foot, pain, numbness, bladder or bowel dysfunction are serious problems might be caused by lumbar disc(s) herniation (LDH) compression. (2) Objective: To evaluate percutaneous discectomy effectivity for decompressing LDH lesions. (3) Case Report: Three patients suffered from drop feet, numbness, and bowel and bladder problems due to LDH compression. Patient #1 is a male (35 years old, basal metabolism index (BMI) = 23.9), point 1 on manual muscle test (MMT), with protrusion on L3 to S1 discs; Patient #2 is a female (62 years old, BMI = 22.4), point 3 on MMT, with protrusion on L2-4 and L5-S1 discs; Patient #3 is a female (43 years old, BMI = 26.6), point 4 on MMT, with extrusion on T12-L1 and L1-2 and L3-4 protruded discs. Six months follow-up showed of stand and walkability improvement with Patient #1 and #2. Patient #3 showed improvement in bowel and bladder problems within 10 weeks, without suffering of postoperative pain syndromes. (4) Discussion: Patient #1 and #2 showed better outcomes than Patient #3 who affected epiconus and cauda equina syndromes. Triamcinolone and lidocaine have analgesic and anti-inflammatory properties for improving intraepidural circulation adjacent to the lesion sites. (5) Conclusion: Drop foot caused by mechanical compression of LDH ought to be treated immediately. Lateral or posterolateral compression has better outcomes associated with anatomical structures. Discectomy through transforaminal approach that is followed by caudal epidural steroid injection (CESI) under fluoroscopic guidance is a safer and minimally invasive treatment with promising outcomes.
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Affiliation(s)
- Trianggoro Budisulistyo
- Department of Neurology, Diponegoro Univ/Dr.Kariadi Hospital, Semarang 50244, Indonesia
- Correspondence:
| | - Firmansyah Atmaja
- Indonesian Army Health Center/Pelamonia Hospital, Makassar 90157, Indonesia;
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23
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Ahn Y. A Historical Review of Endoscopic Spinal Discectomy. World Neurosurg 2020; 145:591-596. [PMID: 32781148 DOI: 10.1016/j.wneu.2020.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 12/23/2022]
Abstract
As an essential component of minimally invasive spine surgery, endoscopic spine surgery (ESS) has continuously evolved and has been accepted as a practical procedure by the worldwide spine community. Especially for lumbar disc herniation (LDH), the percutaneous endoscopic or full-endoscopic discectomy technique has been scientifically proven through randomized controlled trials and meta-analyses to be a good alternative to open discectomy. The initial concept of endoscopic spine discectomy was concerned with indirect disc decompression using various instruments such as blind forceps, a nucleotome, laser, radiofrequency coblation, and some chemical agents. The main surgical field has been shifted from the intradiscal space to the epidural space. Precise and selective discectomy for extruded LDH in the epidural space under high-quality endoscopic visualization is now feasible. Furthermore, the medical applications of ESS is broadening to include spinal stenosis, segmental instability, infection, and even intradural lesions. In this review article, I describe the history of endoscopic spine discectomy and decompression techniques, as well as evolution of the paradigm. This history may help indicate the future of practical ESS.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.
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24
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Khandge AV, Kim JS. Modified Interlaminar Endoscopic Lumbar Discectomy for Highly Upmigrated Disc Herniation: A Proctorship Description of the Technique via Translaminar Route. Neurospine 2020; 17:S66-S73. [PMID: 32746519 PMCID: PMC7410377 DOI: 10.14245/ns.2040264.132] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 06/09/2020] [Indexed: 12/12/2022] Open
Abstract
Lumbar disc herniation (LDH) comprises one of the most common causes of low back pain. 35%–72% of LDH is associated with disc fragment migration. The migration of the disc fragments can be high-grade up, low-grade up, high-grade down, and low-grade down. Spine surgeons deal with unique challenges during surgical management of migrated discs. Operational challenges with open surgery include extensive lamina excision, pars excision, and potential for iatrogenic instability without fixation. In contrast, rigid instruments and poor visualization are the challenges with transforaminal endoscopic spine surgery (ESS). Hence interlaminar approach with ESS is an excellent choice with these migrated LDH. The creation of a translaminar crater in the cranial lamina without dealing with the interlaminar window or ligamentum flavum could be an excellent option to deal with these herniations face front. The lamina is the only anatomical barrier between the endoscope and the migrated disc fragment. Hence with a translaminar approach, unnecessary flavectomy can be avoided. In this technical report and video, we demonstrate the surgical technique of performing the translaminar ESS for highly upmigrated LDH with the preservation of optimal natural anatomy.
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Affiliation(s)
| | - Jin-Sung Kim
- Department of Neurosurgery, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea
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25
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Heo DH, Lee DK, Lee DC, Kim HS, Park CK. Fully Endoscopic Transforaminal Lumbar Discectomy for Upward Migration of Upper Lumbar Disc Herniation: Clinical and Radiological Outcomes and Technical Considerations. Brain Sci 2020; 10:brainsci10060363. [PMID: 32532092 PMCID: PMC7349390 DOI: 10.3390/brainsci10060363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 11/17/2022] Open
Abstract
Microdiscectomy for the upward migration of upper lumbar herniated discs has a high risk of isthmus and facet injury. Fully endoscopic transforaminal discectomy can preserve normal bony structures during discectomy. The purpose of this study was to assess the clinical and radiological outcomes of fully endoscopic transforaminal discectomy for upward migrated upper lumbar herniated discs. All patients had upward migrated disc herniation from L1–L2 to L3–L4 levels and were treated using fully endoscopic transforaminal discectomy under local anesthesia. All enrolled patients were monitored for more than 12 months. Clinical outcomes were assessed using the Oswestry Disability Index (ODI) and visual analog scale (VAS) of pain. Surgery-related complications were analyzed. In addition, radiological outcomes were investigated using postoperative magnetic resonance imaging (MRI) and lumbar dynamic X-ray. Twenty-eight patients were enrolled in this study. ODI and VAS significantly decreased after endoscopic transforaminal discectomy. Migrated ruptured disc particles were completely removed and confirmed on postoperative MRI in 26 of the 28 patients. Even though small remnant disc particles were detected in two patients, symptoms improved after endoscopic transforaminal discectomy. Early recurrence of herniated disc occurred at the operated segment in one patient. There were no significant complications associated with fully endoscopic transforaminal discectomy. Three patients experienced a postoperative transient tingling sensation and numbness of the leg. Fully endoscopic transforaminal lumbar discectomy may be an effective and alternative treatment option for upward migrated disc herniation in the upper lumbar area. In addition, fully endoscopic transforaminal lumbar discectomy may prevent complications associated with general endotracheal anesthesia and injuries of the isthmus and the facet joint.
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Affiliation(s)
- Dong Hwa Heo
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
| | - Dong Keun Lee
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
| | - Dong Chan Lee
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
- Correspondence: ; Tel.: +82-1577-8382
| | - Hyeun Sung Kim
- Department of Neurosurgery, Gangnam Nanoori Hospital, Seoul 06048, Korea;
| | - Choon Keun Park
- Department of Neurosurgery, Spine center, The Leon Wiltse Memorial Hospital, Suwon 16444, Korea; (D.H.H.); (D.K.L.); (C.K.P.)
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26
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Li L, Hai Y, Yang J, Xu C, Yuan J, Sun J, Wang Q, Yang X. Correlation between preoperative CT imaging parameters and clinical outcome of lumbar spinal stenosis treated with endoscopic transforaminal decompression. J Int Med Res 2020; 48:300060519894078. [PMID: 32339040 PMCID: PMC7218480 DOI: 10.1177/0300060519894078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate clinical effects, and their correlations with preoperative computed tomography imaging parameters, in cases of lumbar spinal stenosis treated by endoscopic transforaminal decompression. Methods This retrospective study included orthopaedic patients who had undergone percutaneous endoscopic lumbar discectomy (PELD) for lumbar spinal stenosis. Clinical symptoms were evaluated by visual analogue scale (VAS), Oswestry Disability Index (ODI) and claudication distance. Overall clinical efficacy was evaluated by Macnab score. Results A total of 87 patients were included. Postoperative wound healing was good without complications. Macnab scores following PELD were ‘excellent’ in 41 cases (47.12%), ‘good’ in 30 cases (34.48%), ‘generally good’ in seven cases (8.04%), and ‘poor’ in nine cases (10.34%). The overall rate of optimal surgery was 81.60%. Postoperative pain (VAS) and ODI scores, and claudication distance, were significantly improved versus preoperative values. The soft tissue invasion ratio of the vertebral canal and invasion ratio of the nerve root canal were correlated with clinical efficacy. Conclusion Positive correlations were observed between clinical efficacy of endoscopic transforaminal decompression and preoperative vertebral canal soft tissue invasion ratio and nerve root canal invasion ratio in patients with lumbar spinal stenosis.
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Affiliation(s)
- Lijun Li
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China.,Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Yong Hai
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Jincai Yang
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Cheng Xu
- MRI Department, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jie Yuan
- CT Department, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jiuqiang Sun
- Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Qinghua Wang
- Department of Nephrology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xiaowen Yang
- Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan, China
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Can H, Unal TC, Dolas I, Guclu G, Diren F, Dolen D, Gomleksiz C, Aydoseli A, Civelek E, Sencer A. Comprehensive Anatomic and Morphometric Analyses of Triangular Working Zone for Transforaminal Endoscopic Approach in Lumbar Spine: A Fresh Cadaveric Study. World Neurosurg 2020; 138:e486-e491. [PMID: 32147551 DOI: 10.1016/j.wneu.2020.02.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study is to provide essential information for endoscopic transforaminal approach by performing morphometric analysis of the triangular working zone (TWZ) in fresh cadavers. METHODS Fifteen fresh human cadavers (9 women and 6 men) with no history of spinal surgery were used in this study. Anatomic dissection of 150 foraminal levels were performed. Significant surgical landmarks constructing TWZ were measured bilaterally from L1-2 to L5-S1 on 15 fresh cadavers. The relationship between traversing roots and intervertebral discs was defined. RESULTS Base, height, and hypotenuse measurements of TWZ were longer as the level lowered. Mean base height and hypotenuse of TWZ were 12.15 mm, 11.29 mm, and 16.69 mm (L1-2); 17.94 mm, 17.18 mm, and 28.03 mm (L5-S1), respectively. TWZ was triangular shaped at the upper lumbar levels (L1-2, L2-3, and L3-4), and trapezoid at the lower lumbar levels (L4-5 and L5-S1). Going down the levels, the exiting root angle was narrower, the mean exiting angle of the L5 root being 28.23°. All L2 and L3 traversing roots and nearly all L4 traversing roots (86.7%) originated from below the disc level. Forty percent of L5 traversing roots originated above the disc level, and 53.3% originated at the disc level. Most S1 traversing roots originated at the proximal margin of the disc level (80%). CONCLUSIONS Our study reveals a detailed morphometric analysis of TWZ. Understanding the foraminal anatomy is crucial for safely performing transforaminal endoscopic surgery. The learning curve of transforaminal surgery can be reduced by garnering knowledge of TWZ anatomy.
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Affiliation(s)
- Halil Can
- Department of Neurosurgery, Biruni University Faculty of Medicine, Istanbul, Turkey; Department of Neurosurgery, Medicine Hospital, Istanbul, Turkey
| | - Tugrul Cem Unal
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
| | - Ilyas Dolas
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Gucluhan Guclu
- Department of Neurosurgery, Bakirkoy Dr Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Furkan Diren
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Duygu Dolen
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cengiz Gomleksiz
- Department of Neurosurgery, Silivri State Hospital, Istanbul, Turkey
| | - Aydin Aydoseli
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Erdinc Civelek
- Department of Neurosurgery, Gaziosmanpasa Taksim Training and Research Hospital, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Percutaneous Endoscopic Transforaminal Discectomy versus Conventional Open Lumbar Discectomy for Upper Lumbar Disc Herniation: A Comparative Cohort Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1852070. [PMID: 32190653 PMCID: PMC7072112 DOI: 10.1155/2020/1852070] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 02/11/2020] [Accepted: 02/21/2020] [Indexed: 01/31/2023]
Abstract
Background Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH. Methods Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria. Results The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate ( Conclusions PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.
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Li L, Chang F, Hai Y, Yang J, Xu C, Yuan J, Sun J, Wang Q, Ding S, Yang X. Clinical effect evaluation and correlation between preoperative imaging parameters and clinical effect of endoscopic Transforaminal decompression for lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:68. [PMID: 32013945 PMCID: PMC6998066 DOI: 10.1186/s12891-020-3076-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to evaluate the clinical effect and correlation between preoperative imaging parameters and the clinical effect of endoscopic transforaminal decompression for lumbar spinal stenosis. Methods In this prospective study, 87 patients from Shanxi Province People’s Hospital met the criteria for lumbar spinal stenosis and were recruited from June 2014 to January 2016. These patients underwent endoscopic transforaminal decompression. The clinical symptoms were evaluated by VAS, ODI, and claudication at 3 and 6 months after surgery. The overall clinical efficacy was evaluated using the MacNab score. Yellow ligament thickness and area of the dural sac were examined by MRI. Bony vertebral canal area, real spinal canal area, nerve root canal bony area, nerve root canal real area, distance between the articular joints, and vertebral canal sagittal diameter were examined by CT. The soft tissue invasion ratio of the vertebral canal and the invasion ratio of the nerve root canal were calculated. Correlations between imaging parameters and age, sex, and clinical efficacy were examined. Results The MacNab scores were excellent in 47% of cases, good in 34%, generally good in 8%, and poor in 11%. VAS, ODI, and claudication were significantly improved compared with the preoperative values (P < 0.01). A significant difference was observed between the 71–81 year age group and the other age groups (P < 0.05). There were good correlations between clinical efficacy and vertebral canal sagittal diameter, distance between the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal. Conclusion Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results. This operation is less effective in patients older than 71 years of age. There were positive correlations between clinical efficacy and the vertebral canal sagittal diameter, the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal.
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Affiliation(s)
- Lijun Li
- Department of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China.,Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Feng Chang
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Yong Hai
- Department of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China.
| | - Jincai Yang
- Department of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Cheng Xu
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Jie Yuan
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Jiuqiang Sun
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Qinghua Wang
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Shengqiang Ding
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Xiaowen Yang
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
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30
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Wu XB, Li ZH, Yang YF, Gu X. Two-level percutaneous endoscopic lumbar discectomy for highly migrated upper lumbar disc herniation: A case report. World J Clin Cases 2020; 8:168-174. [PMID: 31970183 PMCID: PMC6962078 DOI: 10.12998/wjcc.v8.i1.168] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 12/04/2019] [Accepted: 12/06/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The technique of percutaneous endoscopic lumbar discectomy (PELD) as a transforaminal approach has been used to treat highly migrated lower lumbar disc herniations. However, due to the different anatomic characteristics of the upper lumbar spine, conventional transforaminal PELD may fail to remove the highly migrated upper lumbar disc nucleus pulposus. Therefore, the purpose of this study was to describe a novel surgical technique, two-level PELD, for the treatment of highly migrated upper lumbar disc herniations and to report its related clinical outcomes.
CASE SUMMARY A 60-year-old male presented with a complaint of pain at his lower back and right lower limb. The patient received 3 mo of conservative treatments but the symptoms were not alleviated. Physical examination revealed a positive femoral nerve stretch test and a negative straight leg raise test for the right leg, and preoperative visual analog scale (VAS) score for the lower back was 6 points and for the right leg was 8 points. Magnetic resonance imaging (MRI) demonstrated L2-L3 disc herniation on the right side and the herniated nucleus pulposus migrated to the upper margin of L2 vertebral body. According to physical examination and imaging findings, surgery was the primary consideration. Therefore, the patient underwent surgical treatment with two-level PELD. The pain symptom was relieved and the VAS score for back and thigh pain was one point postoperatively. The patient was asymptomatic and follow-up MRI scan 1 year after operation revealed no residual nucleus pulposus.
CONCLUSION Two-level PELD as a transforaminal approach can be a safe and effective procedure for highly migrated upper lumbar disc herniation.
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Affiliation(s)
- Xin-Bo Wu
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Zi-Hua Li
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Yun-Feng Yang
- Department of Orthopedics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai 200065, China
| | - Xin Gu
- Department of Orthopedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
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Byvaltsev VA, Kalinin AA, Konovalov NA. [Minimally invasive spinal surgery: stages of development]. ZHURNAL VOPROSY NEĬROKHIRURGII IMENI N. N. BURDENKO 2019; 83:92-100. [PMID: 31825380 DOI: 10.17116/neiro20198305192] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In recent decades, spinal surgery has changed significantly. The active use of modern knowledge of anatomy, various diagnostic modules, specialized surgical equipment and high-tech tools has made it possible to transform classical surgical techniques into a new area of spinal neurosurgery - minimally invasive spine surgery (MISS). Its main goals are to reduce damage to the skin and adjacent tissues, significantly reduce the level of pain, reduce the duration of inpatient treatment and fully restore functional status in the shortest possible time. This article reflects the main criteria for MISS compliance and types of surgical interventions, provides information on the advantages of minimally invasive surgical technologies and their possible disadvantages. Currently, the use of MISS is observed in all areas of vertebrology - for degenerative diseases, tumors, inflammatory and traumatic lesions of the spine. At the same time, minimizing surgical aggression while maximizing the achievement of goal becomes the main rule of modern spinal surgery.
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Affiliation(s)
- V A Byvaltsev
- Irkutsk State Medical University of Ministry of Health, Irkutsk, Russia; Route clinical hospital at train station Irkutsk-Passenger of JSC 'Russian Railroads', Irkutsk, Russia; Irkutsk Scientific Center of surgery and traumathology, Irkutsk, Russia; Irkutsk State Medical Academy of Postgraduate Education, Irkutsk, Russia
| | - A A Kalinin
- Irkutsk State Medical University of Ministry of Health, Irkutsk, Russia; Route clinical hospital at train station Irkutsk-Passenger of JSC 'Russian Railroads', Irkutsk, Russia
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Dannebrock FA, Zardo EDA, Ziegler MS, Severo CMD, Abramczuk J, Vialle E, Radaelli G, Schwanke CHA, Soder RB. EVALUATION OF THE LUMBAR SAFETY TRIANGLE THROUGH MAGNETIC RESONANCE IMAGING. COLUNA/COLUMNA 2019. [DOI: 10.1590/s1808-185120191804196935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To evaluate the lumbar triangular safety zone, its boundaries and its relationship with the dorsal root ganglion through Magnetic Resonance Imaging (MRI). Methods: The boundaries, shape and dimensions of 303 triangular safety zones were analyzed in Tesla 3.0 Magnetic Resonance Imaging (MRI) coronal sections from L2 to L5, including the dorsal root ganglion. Results: The sample consisted of 101 patients with a mean age of 32 years. The height of the triangular safety zone was formed by the lateral edge of the dura mater, the width by the upper plateau of the lower vertebra and the hypotenuse by the corresponding nerve root. The mean dimensions and the area varied according to the level studied. The dorsal root ganglion invaded the dimensions of the triangle in all the images studied. Conclusion: Based on the data and the analyses performed, we concluded that knowledge of the boundaries of the triangular safety zone through MRI increases the safety of minimally invasive procedures in the lumbar spine. Level of evidence I; Diagnostic studies – Investigation of a diagnostic test.
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Affiliation(s)
| | | | | | | | - Joel Abramczuk
- Pontifícia Universidade Católica do Rio Grande do Sul, Brazil
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Elkatatny AAAM, Hamdy TM, Moenes KM. Comparison between Results of Microdiscectomy and Open Discectomy in Management of High-Level Lumbar Disc Prolapse. Open Access Maced J Med Sci 2019; 7:2851-2857. [PMID: 31844448 PMCID: PMC6901859 DOI: 10.3889/oamjms.2019.679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 11/09/2022] Open
Abstract
AIM This work aims to compare between results of microdiscectomy and open discectomy in management of high-level lumbar disc prolapse. METHODS This is a controlled randomised study, where patients having upper lumbar disc herniations were evaluated preoperatively both clinically and radiologically, randomisation was planned to perform open discectomy in odd number patients and to perform microdiscectomy in even number patients, patients were evaluated and followed up for deficits and outcomes. RESULTS We operated ten patients in this study, five cases were operated upon with microdiscectomy, and five cases were operated upon with open discectomy, the median age of presentation in this study was 44 years, there were five males and five females, postoperative pain improvement was better in microdiscectomy. Hospital stay, blood loss, bone loss and postoperative complications were less in microdiscectomy. CONCLUSION Microdiscectomy allows good surgical visualisation and is less traumatic to the involved tissues. The results of this study indicated that microsurgery reduces hospitalisation time, improves the overall surgery-related outcome. The main differences between the two procedures were the length of the incision and blood loss. We found that lumbar microdiscectomy allows patients earlier return to work and normal life with less reliance on postoperative narcotic analgesic agents.
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Affiliation(s)
| | - Tarek M. Hamdy
- Department of Neurosurgery Kasr Alainy Medical school, Cairo University, Cairo, Egypt
| | - Khaled Mamoun Moenes
- Department of Neurosurgery Kasr Alainy Medical school, Cairo University, Cairo, Egypt
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Lin TY, Wang YC, Chang CW, Wong CB, Cheng YH, Fu TS. Surgical Outcomes for Upper Lumbar Disc Herniation: Decompression Alone versus Fusion Surgery. J Clin Med 2019; 8:jcm8091435. [PMID: 31514297 PMCID: PMC6780085 DOI: 10.3390/jcm8091435] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/25/2019] [Accepted: 09/09/2019] [Indexed: 02/05/2023] Open
Abstract
Upper lumbar herniated intervertebral disc (HIVD), defined as L1-2 and L2-3 levels, presents with a lower incidence and more unfavorable surgical outcomes than lower lumbar levels. There are very few reports onthe appropriate surgical interventions for treating upper lumbar HIVD. This study aimed to evaluate the surgical outcome of decompression alone, when compared with spinal fusion surgery. A retrospective study involving a total of 7592 patients who underwent surgery due to HIVD in our institution was conducted. A total of 49 patients were included in this study: 33 patients who underwent decompression-only surgery and 16 patients who underwent fusion surgery. Demographic data, perioperative information, and functional outcomes were recorded. The visual analog scale (VAS) scores showed improvement in both groups postoperatively. The three-month postoperative Oswestry Disability Index score was significantly better in the fusion group. Additionally, 10 patients (76.9%) in the decompression group and 5 patients (83.3%) in the fusion group reported improvement in preoperative motor weakness. The final “satisfactory” rate was 66.7% in the decompression group and 93.8% in the fusion group (p = 0.034). The overall surgical outcomes of patients with upper lumbar HIVD were satisfactory in this study without any major complications. More reliable satisfactory rates and better functional scores at the three-month postoperative follow-up were reported in the fusion group.
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Affiliation(s)
- Tung-Yi Lin
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ying-Chih Wang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chia-Wei Chang
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chak-Bor Wong
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - You-Hung Cheng
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tsai-Sheng Fu
- Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Keelung branch, Keelung 204 and School of medicine, Chang Gung University, Taoyuan 333, Taiwan.
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Yüce I, Kahyaoğlu O, Mertan P, Çavuşoğlu H, Aydın Y. Analysis of clinical characteristics and surgical results of upper lumbar disc herniations. Neurochirurgie 2019; 65:158-163. [PMID: 31100349 DOI: 10.1016/j.neuchi.2019.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 04/08/2019] [Accepted: 04/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Upper lumbar disc herniation (ULDH) is described mostly in levels L1-2, L2-3 and L3-4 of the lumbar spine in the literature and accounts for less than 10% of all disc herniations. The aim of our study was to evaluate the clinical characteristics and surgical results of ULDH. METHODS In all, 367 patients treated for upper lumbar disc herniation and 2137 treated for lower lumbar disc herniation (LLDH) between January 2008 and January 2017 were included. They were followed up postoperatively at 12 months by radiological investigations, back and leg pain Visual Analogue Scale (VAS), and Oswestry Disability Index (ODI). Preoperative data comprised age group (20-40, 40-60, 60-80 years), gender (male, female), lumbar level (L1-2, L2-3, L3-4), side of disc herniation (left, right) and symptom duration (0-3, 3-6, 6-9 months). RESULTS ODI and VAS scores improved significantly postoperatively for all patients. Of the 367 ULDH patients, 169 were female (54%) and 198 male (46%), with a mean age of 55.8±10.1 years (range, 35-71). In 174 (47.4%) patients symptom duration was 3 months, in 99 (27.0%) 3-6 months, and in 94 (25.6%) 6-9 months. At 12 months, ODI, back and leg pain VAS scores showed a significant difference in improvement according to ULDH symptom duration<3 months and to LLDH symptom duration<6 months. CONCLUSION Microdiscectomy in ULDH provided sufficient and safe decompression of neural structures, with significant reduction in symptoms and disability. We suggest that early surgical treatment is an important factor for good outcome in ULDH.
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Affiliation(s)
- I Yüce
- Acıbadem Mehmet Ali Aydınlar University, Vocational School of Health Services, Kayışdağı Caddesi No 32, Ataşehir, İstanbul, Turkey.
| | - O Kahyaoğlu
- Acıbadem Healthcare Group, Fulya Hospital, Dikilitaş Mahallesi, Hakkı Yeten Cd. N(o) 23, Beşiktaş, Istanbul, Turkey.
| | - P Mertan
- Ruprecht-Karls University of Heidelberg, Medical Faculty, Heidelberg, Germany.
| | - H Çavuşoğlu
- Acıbadem Mehmet Ali Aydınlar University, Vocational School of Health Services, Kayışdağı Caddesi No 32, Ataşehir, İstanbul, Turkey.
| | - Y Aydın
- Acıbadem Healthcare Group, Fulya Hospital, Dikilitaş Mahallesi, Hakkı Yeten Cd. N(o) 23, Beşiktaş, Istanbul, Turkey.
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Pairaiturkar PP, Sudame OS, Pophale CS. Evaluation of Dimensions of Kambin's Triangle to Calculate Maximum Permissible Cannula Diameter for Percutaneous Endoscopic Lumbar Discectomy : A 3-Dimensional Magnetic Resonance Imaging Based Study. J Korean Neurosurg Soc 2019; 62:414-421. [PMID: 31079448 PMCID: PMC6616981 DOI: 10.3340/jkns.2018.0091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/01/2018] [Indexed: 12/25/2022] Open
Abstract
Objective To evaluate 3-dimensional magnetic resonance imaging (MRI) of Kambin’s safe zone to calculate maximum cannula diameter permissible for safe percutaneous endoscopic lumbar discectomy.
Methods Fifty 3D MRIs of 19 males and 31 females (mean, 47 years) were analysed. Oblique, axial and sagittal views were used for image analysis. Three authors calculated the inscribed circle (cannula diameter) individually, within the neural (original) and bony Kambin’s triangle in oblique views, disc heights on sagittal views and root to facet distances at upper and lower end plate levels on axial views and their averages were taken.
Results The mean root to facet distances at upper end plate level measured on axial sections increased from 3.42±3.01 mm at L12 level to 4.57±2.49 mm at L5S1 level. The mean root to facet distances at lower end plate level measured on axial sections also increased from 6.07±1.13 mm at L12 level to 12.9±2.83 mm at L5S1 level. Mean maximum cannula diameter permissible through the neural Kambin’s triangle increased from 5.67±1.38 mm at L12 level to 9.7±3.82 mm at L5S1 level. The mean maximum cannula diameter permissible through the bony Kambin’s triangle also increased from 4.03±1.08 mm at L12 level to 6.11±1 mm at L5S1 level. Only 2% of the 427 bony Kambin’s triangles could accommodate a cannula diameter of 8mm. The base of the bony Kambin’s triangle taken in oblique view (3D MRI) was significantly higher than the root to facet distance at lower end plate level taken in axial view.
Conclusion The largest mean diameter of endoscopic cannula passable through “bony” Kambin’s triangle was distinctively smaller than the largest mean diameter of endoscopic cannula passable through “neural” Kambin’s triangle at all levels. Although proximity of exiting root to the facet joint is always taken into consideration before PELD procedure, our 3D MRI based anatomical study is the first to provide actual maximum cannula dimensions permissible in this region.
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Extradiscal Epiduroscopic Percutaneous Endoscopic Discectomy for Upper Lumbar Disc Herniation A Technical Note. Clin Spine Surg 2019; 32:98-103. [PMID: 30531356 DOI: 10.1097/bsd.0000000000000755] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN This study was a technical case report. OBJECTIVES To introduce a new transforaminal percutaneous endoscopic lumbar discectomy (PELD) technique for the treatment of upper lumbar disc herniation using an extradiscal epiduroscopic approach. SUMMARY OF BACKGROUND DATA Although upper lumbar disc herniation accounts for only 1%-2% of all cases of lumbar disc herniation, the treatment is difficult and shows relatively poor outcomes compared with lower lumbar disc herniation. The anatomic characteristics of the upper lumbar spine are somewhat different from those of the lower lumbar spine. Thus, conventional transforaminal PELD may fail to remove the herniated disc. METHODS In the setting of extradiscal epiduroscopic PELD for upper lumbar disc herniation, the approach angle on the axial plane is ~30 degrees, which is less than that of the conventional transforaminal endoscopic discectomy and the working cannula is directly targeted to the herniated disc. Four patients who presented with back and/or leg pain due to disc herniation at L1-L2 or L2-L3 disc space were treated with extradiscal epiduroscopic PELD. RESULTS The patients experienced relief from symptoms and were discharged the next day. CONCLUSIONS Extradiscal epiduroscopic PELD is a promising treatment strategy for upper lumbar disc herniation, which may otherwise lead to a poor outcome.
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Nam HGW, Kim HS, Lee DK, Park CK, Lim KT. Percutaneous Stenoscopic Lumbar Decompression with Paramedian Approach for Foraminal/Extraforaminal Lesions. Asian Spine J 2019; 13:672-681. [PMID: 30909675 PMCID: PMC6680032 DOI: 10.31616/asj.2018.0269] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
The lumbar foramen is affected by different degenerative diseases, including extraforaminal disc herniation, foraminal stenosis (FS), and degenerative or spondylolytic spondylolisthesis. The purpose of this study was to describe percutaneous stenoscopic lumbar decompression with a paramedian approach (para-PSLD) for foraminal/extraforaminal lesions. All operative procedures were performed using a complete uniportal endoscopic instrument system. The para-PSLD can be easily applied to patients with FS and narrow disc space or facet joint hypertrophy. The anatomical view of a para-PSLD is similar to that of a conventional open surgery and allows for good visualization of the foraminal/extraforaminal areas. We suggest that para-PSLD is an alternative and minimally invasive procedure to treat degenerative lumbar foraminal/extraforaminal stenoses.
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Affiliation(s)
- Han Ga Wi Nam
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Hyung Suk Kim
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Dong Keun Lee
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Chun-Kun Park
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
| | - Kang Taek Lim
- Department of Neurosurgery, Good Doctor Teun Teun Hospital, Anyang, Korea
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Kapetanakis S, Chaniotakis C, Angoules AG. Full Endoscopic Discectomy Using Transforaminal Endoscopic Spine System Technique: A Mini Review of Complications. Open Orthop J 2019. [DOI: 10.2174/1874325001913010076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background:Full Endoscopic Discectomy (FED) is a minimally invasive technique for the treatment of Lumbar Disk Herniation (LDH) with increasing popularity among surgeons in the recent years. This alternative to conventional procedures surgical approach is generally a safe and efficient technique possessing many advantages such as less soft tissue trauma, preservation of dorsal musculature, and reduced perioperative morbidity and rapid recovery. However, FED is associated with a number of complications such as postoperative dysesthesia, nerve root injury, and dural tears.Methods:Α search of PubMed, Google Scholar and Scopus electronic databases was used to revised the literature on complications of full endoscopic discectomy using transforaminal endoscopic spine system techniqueConclusion:In this review complications associated with FED are analyzed, emphasizing on the potential beneficial role of Transforaminal Endoscopic Spine System (TESSYS) technique in reducing their frequency.
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Liu W, Li Q, Li Z, Chen L, Tian D, Jing J. Clinical efficacy of percutaneous transforaminal endoscopic discectomy in treating adolescent lumbar disc herniation. Medicine (Baltimore) 2019; 98:e14682. [PMID: 30817599 PMCID: PMC6831190 DOI: 10.1097/md.0000000000014682] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Ten years ago, endoscopic techniques began to prevail in clinical treatment of lumbar disc herniation (LDH), but to date, few studies have reported the clinical efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in treating adolescent LDH. This study aimed to evaluate the surgical outcomes of PTED in treating adolescent patients with LDH.Between June 2012 and June 2016, retrospective analysis of 43 adolescent patients diagnosed with single-segment LDH at spine surgery at the Second Affiliated Hospital of Anhui Medical University. The patients' lower limb pain was evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). The VAS is the most commonly-used quantitative method for assessing the degree of pain in clinical practice. The measurement method is to draw a 10 cm horizontal line on a piece of paper, 1 end of which is 0, indicating no pain, while the other end is 10, which means severe pain, and the middle part indicates different degrees of pain. The clinician then asks the patient to make a mark on the line to indicate the degree of pain based on how he or she feels. The ODI is the most widely-used assessment method internationally for lumbar or leg pain at present. The ODI questionnaire is composed of 10 questions, covering pain intensity, independent living, carrying, walking, sitting, standing, sleep, travel, sex, and social life. Every category comprises 6 options, with the highest score for each question being 5 points. Thus the 1st option is worth 0 points, the last option scores 5 points, and higher scores represent more serious dysfunction. Patient satisfaction was evaluated using the modified MacNab score. Clinical outcomes were measured preoperatively, and at 3 days, 6 months, and 12 months postoperatively.All 43 patients were followed up for 12 to 24 months. The average follow-up time was 18.33 months. The VAS scores and ODI scores at 3 days, 6 months, and 12 months postoperatively were significantly lower than before surgery. The difference was statistically significant (P < .001). The differences in VAS scores and ODI scores at 3 days, 6 months, and 12 months after surgery were also statistically significant (P < .001). According to the modified MacNab criteria, 26 cases were rated excellent, 14 cases were good, and 3 cases were acceptable at the final follow-up, and 93.02% of these patients had excellent outcomes.The PTED is an effective and safe surgical method for the treatment of adolescent patients with LDH, but high-quality randomized controlled trials are still required to further verify these findings.
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Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4749560. [PMID: 30671454 PMCID: PMC6323537 DOI: 10.1155/2018/4749560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022]
Abstract
Purpose Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. Methods In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. Results Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. Conclusion The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.
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Foraminoplasty at the Tip or Base of the Superior Articular Process for Lateral Recess Stenosis in Percutaneous Endoscopic Lumbar Discectomy: A Multicenter, Retrospective, Controlled Study with 2-Year Follow-Up. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7692794. [PMID: 30662915 PMCID: PMC6313963 DOI: 10.1155/2018/7692794] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 12/06/2018] [Indexed: 12/17/2022]
Abstract
Objective To compare the clinical efficacy and complications which obtained foraminoplasty at the tip or base of the superior articular process (SAP) for the patients with lateral recess stenosis treated by percutaneous endoscopic lumbar discectomy (PELD). Methods Between January 2015 and January 2016, 156 patients of lumbar disc herniation accompanying with lateral recess stenosis were treated with PELD in five tertiary hospitals and fulfilled the 2-year follow-up. Among them, 78 patients obtained a foraminoplasty at the tip of SAP (group A), and foraminoplasty at the base of SAP was performed in the other 78 cases (group B). Clinical efficacy was evaluated using the visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and 36-item Short-Form Health Survey (SF-36) score. The intervals of follow-up were scheduled at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Results Mean operative duration is shorter in group B (55 versus 61 min, P = 0.047). Only one case belonged to group A could not tolerate the neural irritation and required conversion to an open procedure. During the surgery, no dura tears, cauda equina syndrome, or infections were observed. 5 patients experienced transient dysesthesia located at the exiting nerve in group A, while no cases complained dysesthesia in group B. 2 cases who suffered temporary motor weakness all belonged to group A. A total of 5 cases obtained a revision surgery after recurrence in the follow-up, in which 3 patients belonged to group A. Compared to the preoperative data, significant improvements in VAS scores of low back pain and sciatica, ODI, and SF-36 PCS and MC were observed in the follow-up, respectively (P < 0.05, respectively). However, no statistical difference was observed at all time-points after surgery between these two groups (P > 0.05, respectively). Conclusions For the patients of LDH accompanying with lateral recess stenosis, compared with the routine foraminoplasty at the tip of SAP, our modified foraminoplastic technique does not only change place of foraminoplasty to the base of SAP but also simplified puncture process in transforaminal PELD. Although there was no significant difference in symptom relief, the modified foraminoplasty showed the advantages in decreasing the incidence of postoperative neural dysfunction and reducing operation time.
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Ahn Y, Lee U, Kim WK, Keum HJ. Five-year outcomes and predictive factors of transforaminal full-endoscopic lumbar discectomy. Medicine (Baltimore) 2018; 97:e13454. [PMID: 30508966 PMCID: PMC6283221 DOI: 10.1097/md.0000000000013454] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Although several studies have reported the effectiveness of transforaminal full-endoscopic lumbar discectomy (TELD), no cohort study on the long-term outcomes of TELD has been conducted. Thus, this study aimed to evaluate the long-term clinical outcomes of TELD and to determine the factors predicting favorable outcome.Five-year longitudinal data of 204 consecutive patients who underwent TELD were collected. Outcomes were assessed using the visual analog scale (VAS) pain score, Oswestry disability index (ODI), patient satisfaction rating, and the modified Macnab criteria.The mean VAS score for leg pain improved from 7.64 at the baseline to 1.71, 0.81, 0.90, and 0.99 at postoperative 6 weeks, 1 year, 2 years, and 5 years, respectively (P <.001). The mean ODI improved from 67.2% at the baseline to 15.7%, 8.5%, 9.4%, and 10.1% at postoperative 6 weeks, 1 year, 2 years, and 5 years, respectively (P <.001). The overall patient satisfaction rate was 94.1%. Based on the modified Macnab criteria, 83.8% of patients had excellent or good results. In this study, younger patients with intracanal disc herniation tended to have better outcomes than elderly patients with foraminal/far-lateral disc herniation (P <.05).Transforaminal endoscopic lumbar discectomy offers favorable long-term outcomes with minimal tissue damage. Postoperative pain and functional status may change over time. Proper patient selection remains essential for the success of this minimally invasive procedure.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Uhn Lee
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Woo-Kyung Kim
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon
| | - Han Joong Keum
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
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Yang H, Li P, Jia N, Jin X, Ding W, Zhang W. [Effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:933-940. [PMID: 30129320 DOI: 10.7507/1002-1892.201711039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Objective To investigate the effect and effectiveness analysis of different approaches of transforaminal endoscope on extirpation amount of nuclues pulposus. Methods Between August 2011 and December 2014, a total of 165 patients with lumbar disc herniation were retrospectively enrolled and were treated with nucleus pulposus discectomy through transforaminal endoscope. The patients were randomly divided into 4 groups according to different approach of transforaminal endoscope. The posterolateral approach (Yeung's technology) was used in group A (42 cases), transforaminal endoscopic spine system (TESSYS) technology was used in group B (40 cases), improved transforaminal endoscopic access (ITEA) technology was used in group C (43 cases), and interlaminar approach (40 cases) was used in group D (40 cases). There was no significant difference in gender, age, disease duration, symptomatic side, and segments among 4 groups ( P>0.05). The extirpation amount of nuclues pulposus was calculated and compared among 4 groups; the effectiveness was evaluated by pre- and post-operative visual analogue scale (VAS) score, Oswestry disability index (ODI), lumbar curvature index (LCI), and intervertebral height. Results The discectomy amount of nucleus pulposus was (3.7±0.8), (3.6±0.7), (4.5±1.1), and (3.0±0.8) cm 3 in groups A, B, C, and D, respectively. The amount of group C was significantly larger than that of the other 3 groups ( P<0.05), and the amount of group D was significantly smaller than that of the other 3 groups ( P<0.05); no significant difference was found between groups A and B ( P>0.05). Cerebrospinal fluid leakage was found in 1 case; no other postoperative complications including intervertebral space infection and epidural hematoma was found. All the incisions healed by first intension. All the patients were followed up 12-24 months (mean, 18 months), and no typical symptoms of recurrence was found during the follow-up period. There was no significant difference in preoperative lower back pain VAS score, lower extremities VAS score, and ODI scores among 4 groups ( P>0.05). The above scores at last follow-up were significantly improved when compared with preoperative ones in each group ( P<0.05), but no significant difference of above scores and recovery values was found among 4 groups ( P>0.05). The difference in LCI and intervertebral height at preoperation and at last follow-up were not significant between 4 groups ( P>0.05). The difference in LCI and intervertebral height of each group between at preoperation and last follow-up were not significant ( P>0.05). And the recovery value of LCI and the lost of height at last follow-up also showed no significant differences between 4 groups ( P>0.05). Conclusion The ITEA technology can give a wider field of view than other technologies. It is more convenient to find and remove the nucleus pulposus. However, the appropriate operative approaches should be chosen according to the symptoms and characteristics of lumbar disc herniation.
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Affiliation(s)
- Hu Yang
- Department of Orthopaedics, Harrison International Peace Hospital, Hengshui Hebei, 053000, P.R.China
| | - Pengfei Li
- Department of Orthopaedics, Harrison International Peace Hospital, Hengshui Hebei, 053000,
| | - Nan Jia
- Department of Orthopaedics, Harrison International Peace Hospital, Hengshui Hebei, 053000, P.R.China
| | - Xianhui Jin
- Department of Orthopaedics, Harrison International Peace Hospital, Hengshui Hebei, 053000, P.R.China
| | - Wenyuan Ding
- Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P.R.China
| | - Wei Zhang
- Department of Spine Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang Hebei, 050051, P.R.China
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Oyelese AA, Fridley J, Choi DB, Telfeian A, Gokaslan ZL. Minimally invasive direct lateral, retroperitoneal transforaminal approach for large L1-2 disc herniations with intraoperative CT navigational assistance: technical note and report of 3 cases. J Neurosurg Spine 2018; 29:46-53. [PMID: 29676674 DOI: 10.3171/2017.11.spine17509] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Upper lumbar (L1-2, L2-3) disc herniations are distinct in their diffuse presenting clinical symptomatology and have poorer outcomes with surgical intervention than those following mid and lower lumbar disc herniations and disc surgery. The authors present the cases of 3 patients with L1-2 disc herniations and significant stenosis of the spinal canal. The surgical approach used here combined the principles of transforaminal percutaneous endoscopic discectomy and the extreme lateral lumbar interbody fusion procedures with intraoperative CT-guided navigational assistance. The approach provides a safe corridor of direct visualization to the ventral thecal sac with minimal bony resection and could, in principle, reduce neurological injury and biomechanical instability, which likely contribute to poor outcomes at this level.
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Zhou YL, Chen G, Bi DC, Chen X. Short-term clinical efficacy of percutaneous transforaminal endoscopic discectomy in treating young patients with lumbar disc herniation. J Orthop Surg Res 2018; 13:61. [PMID: 29558942 PMCID: PMC5861648 DOI: 10.1186/s13018-018-0759-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/07/2018] [Indexed: 12/26/2022] Open
Abstract
Background In the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, few studies have described the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in treating younger patients with LDH. This study aims to evaluate the preliminary surgical outcome and complication of PTED in treating younger patients with LDH. Methods Between June 2012 and June 2016, 72 young patients (< 45 years old) who underwent PTED for single-level LDH were prospectively followed up. All patients were followed up for at least 12 months (range 12–35 months). Pain was measured using visual analogue scale (VAS) scores. Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively, at 2 days and 6 months, and 12 months postoperatively. Results The mean VAS score for back pain was 5.1 ± 2.3 preoperatively and 3.1 ± 1.2, 2.1 ± 0.5, and 2.0 ± 0.7 at 2 days, 6 months, and 12 months postoperatively, respectively. The VAS score for leg pain was 7.1 ± 2.6 preoperatively and 3.0 ± 1.1, 2.1 ± 1.3, and 1.9 ± 0.8 at 2 days, 6 months, and 12 months postoperatively, respectively. These postoperative scores were all significantly different when compared with preoperative scores (P < 0.001). According to the modified MacNab outcome scale, excellent was obtained in 43 patients, good was obtained in 25 patients, and fair was obtained in 4 patients, and 94.44% of these patients had excellent and good outcomes at the final follow-up. There were no complications related to surgery, and no spinal instability was detected. Conclusion PTED appears to be an effective and safe intervention for younger patients with LDH. High-quality randomized controlled trials are required to further study the efficacy and safety of PTED in treating younger patients with LDH.
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Affiliation(s)
- You-Long Zhou
- Department of Orthopedics, Changxing People's Hospital, Huzhou, 310009, China.,Department of Orthopedics, Changxing Branch of 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Gang Chen
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jie fang Road, Hangzhou, 310009, China.
| | - Dao-Chi Bi
- Department of Orthopedics, Changxing People's Hospital, Huzhou, 310009, China.,Department of Orthopedics, Changxing Branch of 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
| | - Xing Chen
- Department of Orthopedics, Changxing People's Hospital, Huzhou, 310009, China.,Department of Orthopedics, Changxing Branch of 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, 310009, China
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Ba Z, Li Z, Liu Z, Li H, Wu D, Zhu J. Eccentric technique for foraminoplasty in percutaneous endoscopic transforaminal procedure: A technical note. Int J Surg 2017; 46:110-113. [PMID: 28882771 DOI: 10.1016/j.ijsu.2017.08.579] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To describe a modified technique usied for foraminoplasty in percutaneous endoscopic transforaminal procedure. METHODS 58 patients (20 males and 38 females, average age 52.5 years) underwent percutaneous endoscopic transforaminal procedure by using our modified technique. Under the guidance of C-arm fluoroscopy, a kirschner wire was inserted into targeted superior articular process. After expanding the soft tissues, a trepan with the largest diameter was located through the kirschner wire and the angle of trepan was flexible enough to adjust to different operative conditions. This technique could help to avoided using step-by-step larger diameters of trepans without slippage during foraminoplasty. RESULTS With our modified technique, the mean operation time was 65 min (range 50-80 min) and mean estimated blood loss was 12 ml (range 10-30 ml). Fluoroscopy was less (the mean duration of fluoroscopy was 20.4 ± 9.2 s and the mean radiation dose was 0.9 ± 0.2 mSv) and no complications occurred. All foraminoplasties were excellent via CT scans after surgery and all patients were discharged on 2nd day after operation. The results of 58 patients with an average follow-up of 18 (6-36) months demonstrated our eccentric technique to be effective. CONCLUSION Our eccentric technique could help to avoid step-by-step larger diameters of trepans during foraminoplasty to shorten operation time and reduced the number of fluoroscopy intraoperative.
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Affiliation(s)
- Zhaoyu Ba
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai 200120, China
| | - Zhiqiang Li
- Dept. of Gushang, Shuguang Hospital, Shanghai Chinese Traditional Medicine University, 528 Zhangheng Rd., Shanghai 201210, China
| | - Zhonghan Liu
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai 200120, China
| | - Haoxi Li
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai 200120, China
| | - Desheng Wu
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai 200120, China.
| | - Jianguang Zhu
- Dept. of Spine Surgery, Shanghai East Hospital, Tongji University School of Medicine, 150 Jimo Rd., Shanghai 200120, China.
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Guan X, Zhao S, Gu X, Zhang H, He S. Guide wire breakage during posterolateral endoscopic lumbar discectomy procedure: A case report. J Back Musculoskelet Rehabil 2017; 30:383-386. [PMID: 27858672 DOI: 10.3233/bmr-150295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To present a unique case of guide wire breakage as a rare complication during posterolateral endoscopic lumbar discectomy. BACKGROUND Posterolateral endoscopic lumbar discectomy (PELD) has become a routinely performed minimally invasive spinal procedure. However, several complications of PELD have attracted our concerns, including the intraoperative injury to neural and vascular structures and failure of the surgery. We have countered a rare intraoperative complication of guidewire breakage during a PELD procedure, as far as we know, this has not been reported previously, and we wish to draw attention to this hazard. METHODS The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. RESULTS A 28-year-old man presented with right posterior sciatica for 3 months was admitted to the hospital. Unsatisfactory improvement was observed under supervised conservative treatment. Preoperative magnetic resonance imaging (MRI) showed a disc herniation at the L4-L5 level. After preoperative evaluation, a PELD procedure was performed with local anesthesia. After advancement of guide wire and discography, the guiding rod was found not in the vicinity of the extruding disc fragment. Therefore, the operator tried to redirect the guiding rod. However, after several attempts, the guide wire was broken in the disc fragment under imaging. With the patient's permit, the operator inserted the working cannula to the broken end of guide wire and retrieved it using straightened grasping forceps. Then foraminotomy and fragmentectomy were accomplished under endoscope. The patient made uneventful recovery and was free of symptoms for the following 6 months. CONCLUSIONS In conclusion, the guide wire breakage during PELD procedures is a rare but a serious complication. An appropriate manner and operation is very important to prevent this complication. Once it does occur, the remnant of the guide wire can possibly be retrieved under endoscope with great experience. However, as for the beginners, a transfer to open operation is suggested to prevent new complications.
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A Modified Translaminar Osseous Channel-Assisted Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated and Sequestrated Disc Herniations of the Upper Lumbar: Clinical Outcomes, Surgical Indications, and Technical Considerations. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3069575. [PMID: 28466008 PMCID: PMC5390599 DOI: 10.1155/2017/3069575] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 02/22/2017] [Indexed: 12/28/2022]
Abstract
Objective is to describe a safe and effective percutaneous endoscopic approach for removal of highly migrated and sequestrated disc herniations of the upper lumbar spine and to report the results, surgical indications, and technical considerations of the new technique. Eleven patients who had highly migrated and sequestrated disc herniations in the upper lumbar were included in this study. A retrospective study was performed for all patients after translaminar osseous channel-assisted PELD was performed. Radiologic findings were investigated, and pre-and postoperative visual analog scale (VAS) assessments for back and leg pain and Oswestry disability index (ODI) evaluations were performed. Surgical outcomes were evaluated under modified MacNab criteria. All of the patients were followed for more than 1 year. The preoperative and postoperative radiologic findings revealed that the decompression of the herniated nucleus pulposus (HNP) was complete. After surgery, the mean VAS scores for back and leg pain immediately improved from 8.64 (range, 7–10) and 8.00 (range, 6–10) to 2.91 (range, 2–4) and 2.27 (range, 1–3), respectively. The mean preoperative ODI was 65.58 (range, 52.2–86), which decreased to 7.51 (range, 1.8–18) at the 12-month postoperative follow-up. The MacNab scores at the final follow-up included nine excellent, one good, and one fair. The modified translaminar osseous channel-assisted PELD could be a safe and effective option for the treatment of highly migrated and sequestrated disc herniations of the upper lumbar.
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