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Saghebdoust S, Khadivar F, Ekrami M, Mehrizi MAA, Lajimi AV, Zahmatkesh MRR, Pak N, Jouibari MF, Mirsaeed SSG, Boustani MR. Transforaminal Endoscopic Lumbar Diskectomy versus Open Microdiskectomy for Symptomatic Lumbar Disk Herniation: A Comparative Cohort Study on Costs and Long-Term Outcomes. J Neurol Surg A Cent Eur Neurosurg 2024; 85:561-569. [PMID: 37879346 DOI: 10.1055/s-0043-1775760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
BACKGROUND Transforaminal endoscopic lumbar diskectomy (TELD) is considered an effective treatment for lumbar disk herniation (LDH). There is a paucity of studies comparing in detail the costs and long-term clinical outcomes of TELD and open microdiskectomy (MD), especially in developing countries. Thus, we sought to provide a multidimensional insight into this matter by comparing the direct costs and long-term outcomes of TELD with those of MD. METHODS The electronic health records of 434 patients with LDH who underwent either TELD or MD were collected from February 2011 to October 2014. Within a 7-year follow-up period, 412 patients, comprising 203 patients treated with TELD and 209 patients treated with MD, were fully evaluated. Patient characteristics, operative time, intraoperative blood loss (IBL), postoperative hospital stay, time to return to work (RTW), perioperative complications, and direct costs were collected. Clinical outcomes were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and modified MacNab criteria. RESULTS The postoperative ODI and VAS scores improved significantly in both groups (p < 0.001). In accordance with the modified MacNab criteria, the rate of excellent and good outcomes was 88.67 and 88.03% in the TELD and MD groups, respectively. There were no significant differences between the groups in the clinical outcomes and perioperative complications. However, IBL, hospital stay, and RTW were significantly reduced in the TELD group (p < 0.05). Twenty-one cases in the TELD group and nine in the MD group underwent reoperation due to recurrence (p < 0.05). Total inpatient cost per patient was $1,596 in the TELD group and $1,990 in the MD group (p < 0.05). CONCLUSION TELD for the treatment of symptomatic LDH could be an affordable strategy, providing certain advantages of minimally invasive procedures such as shorter hospital stay and earlier recovery along with comparable clinical outcomes to the conventional surgical method.
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Affiliation(s)
- Sajjad Saghebdoust
- Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farshid Khadivar
- Department of Clinical Sciences, Faculty of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mehran Ekrami
- Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Amir Valinezhad Lajimi
- Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Reza Rouhbakhsh Zahmatkesh
- Department of Neurosurgery, Razavi Hospital, Mashhad, Iran
- Department of Neurosurgery, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Pak
- Department of Radiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Faghih Jouibari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Mohammad Reza Boustani
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Golestan Hospital, Tehran, Iran
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Trathitephun W, Asawasaksakul A, Jaruwanneechai K, Pakdeenit B, Suebsing A, Liu Y, Kim JS, Suvithayasiri S. Intraoperative Management of Iatrogenic Durotomy in Endoscopic Spine Surgery: A Systematic Review. Neurospine 2024; 21:756-766. [PMID: 39363456 DOI: 10.14245/ns.2448346.173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/23/2024] [Indexed: 10/05/2024] Open
Abstract
This review aims to systematically evaluate the incidence, management strategies, and clinical outcomes of iatrogenic durotomy (ID) in endoscopic spine surgery and to propose a management flowchart based on the tear size and associated complications. A comprehensive literature search was conducted, focusing on studies involving endoscopic spinal procedures and incidental durotomy. The selected studies were analyzed for management techniques and outcomes, particularly in relation to the size of the dural tear and the presence of nerve root herniation. Based on these findings, a flowchart for intraoperative management was developed. A total of 14 studies were included, encompassing 68,546 patients. Varying incidences of ID, with management strategies largely dependent on the size of the dural tear, were found. Small tears (less than 5 mm) were often left untreated or managed with absorbable hemostatic agents, while medium (5-10 mm) and large tears (greater than 10 mm) required more complex approaches like endoscopic patch repair or open surgery. The presence of nerve root herniation necessitated immediate action, often influencing the decision to convert to open repair. Effective management of ID in endoscopic spine surgery requires a nuanced approach tailored to the size of the tear and specific intraoperative challenges, such as nerve root herniation. The proposed flowchart offers a structured approach to these complexities, potentially enhancing clinical outcomes and reducing complication rates. Future research with more rigorous methodologies is necessary to refine these management strategies further and broaden the applications of endoscopic spine surgery.
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Affiliation(s)
- Warayos Trathitephun
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | | | | | - Abhirat Suebsing
- Department of Orthopedics, Warinchamrab Hospital, Ubon Ratchathani, Thailand
| | - Yanting Liu
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Siravich Suvithayasiri
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand
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Xu P, Yuan J, Wu T, He D, Miao X, Cheng X. Modified Percutaneous Endoscopic Interlaminar Discectomy through the Near-spinous Process Approach for L4/5 Disc Herniation: A Retrospective Clinical Study. Orthop Surg 2024; 16:1064-1072. [PMID: 38556483 PMCID: PMC11062861 DOI: 10.1111/os.14031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 04/02/2024] Open
Abstract
OBJECTIVE Compared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain, so it has been widely used in the field of spinal surgery. However, it still has the defect of intraoperative fluoroscopy occurrences, complications, and even the risk of damage to the spinal cord and nerve. This study aims to compare the clinical efficacy of modified percutaneous endoscopic interlaminar discectomy (MPEID) with percutaneous endoscopic transforaminal discectomy (PETD) in treating L4/5 lumbar disc herniation (LDH) and to evaluate the effectiveness and safety of MPEID. METHODS Thirty-four L4/5 LDH patients treated at the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were studied retrospectively. Seventeen underwent MPEID and seventeen PETD. Variables analyzed included demographics, operative duration, intraoperative fluoroscopy occurrences, and surgical outcomes. Effectiveness was evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. Lumbar Magnetic Resonance Imaging (MRI) was used to assess radiological outcomes. A paired t-test was performed to compare intragroup pre- and postoperative clinical data, VAS, and ODI scores. RESULTS The average operative time in PETD group was 91.65 ± 14.04 min, and the average operative time in MPEID group was 65.41 ± 12.61 min (p < 0.001). In PETD group, the fluoroscopy occurrences averaged 9.71 ± 1.05 times, with fluoroscopy occurrences averaging 6.47 ± 1.00 times (p < 0.001) in MPEID group. At 12 months follow-up, the clinical effect showed significant improvement in both two groups. The MPEID group showed a decrease in average VAS-back score from 5.41 ± 2.18 to 1.76 ± 1.09 (p < 0.001) and VAS-leg score from 6.53 ± 1.66 to 0.82 ± 0.64 (p < 0.001). The ODI scores decreased from 51.35 ± 10.65 to 11.71 ± 2.91 (p < 0.001). In the PETD group, the VAS-back score decreased from 4.94 ± 1.98 to 2.06 ± 1.25 (p < 0.001), VAS-leg score from 7.12 ± 1.73 to 1.12 ± 0.60 (p < 0.001), and ODI scores from 48.00 ± 11.62 to 12.24 ± 2.56 (p < 0.001). According to the modified MacNab criteria, MPEID had 15 excellent and two good results; PETD had 12 excellent and 5 good (p = 0.23). No nerve root injuries, dural tears, or significant complications were reported. CONCLUSION MPEID and PETD effectively treat L4/5 LDH, with MPEID showing shorter operative times and fewer fluoroscopies. Furthermore, the MPEID group can provide excellent clinical efficacy as the PETD group in the short term.
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Affiliation(s)
- Peichuan Xu
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Jinghong Yuan
- Institute of Orthopedics of Jiangxi ProvinceNanchangChina
| | - Tianlong Wu
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Dingwen He
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Xinxin Miao
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Xigao Cheng
- Department of OrthopedicsThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
- Institute of Orthopedics of Jiangxi ProvinceNanchangChina
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Zhang G, Xie X, Liu N. EFFICACY OF FULL-ENDOSCOPIC INTERLAMINAR AND TRANSFORAMINAL DISCECTOMY FOR LUMBER DISC HERNIATION. ACTA ORTOPEDICA BRASILEIRA 2023; 31:e263326. [PMID: 37876861 PMCID: PMC10592370 DOI: 10.1590/1413-785220233105e263326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 11/22/2022] [Indexed: 10/26/2023]
Abstract
A previous study has reported the therapeutic effects of interlaminar/transforaminal approaches under full-endoscopic visualization to treat L5-S1 lumber disc herniation (LDH). However, the comparison of interlaminar/transforaminal approaches to treat other segments of LDH remains unclear. OBJECTIVE To evaluate the clinical efficacy of full-endoscopic interlaminar and transforaminal lumbar discectomy to treat LDH. METHODS A total of 93 patients with LDH who underwent fully-endoscopic lumbar interlaminar/transforaminal discectomy were retrospectively collected. Patients were divided into a Transforaminal group (n=41) and an Interlaminar group (n=52). Clinical efficacy was evaluated by visual analogue scale (VAS), the Oswestry disability index (ODI), and the modified MacNab scoring system. RESULTS Of the 93 patients, involving segments in LDH referred to L3-4, L4-5, and L5-S1. The fluoroscopy times in the Interlaminar group were smaller than that of the Transforaminal group. We found no obvious significances between the Transforaminal and Interlaminar groups regarding operation time, incision length, postoperative landing time, hospitalization, and incision healing time. Postoperative VAS and ODI scores notably improved at follow-up. Besides, almost 90% LDH patients achieved excellent/good outcomes. CONCLUSION The full-endoscopic visualization technique via interlaminar and transforaminal approaches safely and effectively treat LDH. Level of Evidence III, Retrospective Study.
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Affiliation(s)
- Guoqiang Zhang
- Capital Medical University, Beijing Friendship Hospital, Department of Orthopedics, Beijing, China
| | - Xuehu Xie
- Capital Medical University, Beijing Friendship Hospital, Department of Orthopedics, Beijing, China
| | - Ning Liu
- Capital Medical University, Beijing Friendship Hospital, Department of Orthopedics, Beijing, China
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Luo M, Wang Z, Zhou B, Yang G, Shi Y, Chen J, Tang S, Huang J, Xiao Z. Risk factors for lumbar disc herniation recurrence after percutaneous endoscopic lumbar discectomy: a meta-analysis of 58 cohort studies. Neurosurg Rev 2023; 46:159. [PMID: 37392260 DOI: 10.1007/s10143-023-02041-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/27/2023] [Indexed: 07/03/2023]
Abstract
Recurrent lumbar disc herniation (rLDH) is one of the most serious complications and major causes of surgical failure and paralysis following percutaneous endoscopic lumbar discectomy (PELD). There are reports in the literature on the identification of risk factors associated with rLDH; however, the results are controversial. Therefore, we conducted a meta-analysis to identify risk factors for rLDH among patients following spinal surgery. PubMed, EMBASE, and the Cochrane Library were searched without language restrictions from inception to April 2018 for studies reporting risk factors for LDH recurrence after PELD. MOOSE guidelines were followed in this meta-analysis. We used a random effects model to aggregate odds ratios (ORs) with 95% confidence intervals (CIs). The evidence of observational studies was classified into high quality (class I), medium quality (class II/III), and low quality (class IV) based on the P value of the total sample size and heterogeneity between studies. Fifty-eight studies were identified with a mean follow-up of 38.8 months. Studies with high-quality (class I) evidence showed that postoperative LDH recurrence after PELD was significantly correlated with diabetes (OR, 1.64; 95% CI, 1.14 to 2.31), the protrusion type LDH (OR, 1.62; 95% CI, 1.02 to 2.61), and less experienced surgeons (OR, 1.54; 95% CI, 1.10 to 2.16). Studies with medium-quality (class II or III) evidence showed that postoperative LDH recurrence was significantly correlated with advanced age (OR, 1.11; 95% CI, 1.05 to 1.19), Modic changes (OR, 2.23; 95% CI, 1.53 to 2.29), smoking (OR, 1.31; 95% CI, 1.00 to 1.71), no college education (OR, 1.56; 95% CI, 1.05 to 2.31), obesity (BMI ≥ 25 kg/m2) (OR, 1.66; 95% CI, 1.11 to 2.47), and inappropriate manual labor (OR, 2.18; 95% CI, 1.33 to 3.59). Based on the current literature, eight patient-related and one surgery-related risk factor are predictors of postoperative LDH recurrence after PELD. These findings may help clinicians raise awareness of early intervention for patients at high risk of LDH recurrence after PELD.
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Affiliation(s)
- Mingjiang Luo
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Zhongze Wang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Beijun Zhou
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Gaigai Yang
- Hengyang Medical School, University of South China, Hengyang City, Hunan Province, China
| | - Yuxin Shi
- Department of Pediatric Dentistry, First Affiliated Hospital (Affiliated Stomatological Hospital) of Xinjiang Medical University, Urumqi, 830054, China
| | - Jiang Chen
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Siliang Tang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Jingshan Huang
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China
| | - Zhihong Xiao
- Department of Spinal Surgery, Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang City, 421000, Hunan Province, China.
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Nair VV, Kohli S, Vishwakarma N, Mhatre J. Outcome of Transforaminal Endoscopic Discectomy in Rural India in a Single-Level Lumbar Disc Prolapse Under Local Anesthesia. Asian J Neurosurg 2023; 18:312-320. [PMID: 37397052 PMCID: PMC10310452 DOI: 10.1055/s-0043-1769756] [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: 07/04/2023] Open
Abstract
Aim The aim of this study was to undertake a clinical study to evaluate the outcomes of transforaminal endoscopic discectomy under local anesthesia and to study the complication rate. Study Design It is a prospective study. Methods We prospectively analyzed outcomes of 60 patients with a single-level lumbar disc prolapse in rural India from December 2018 to April 2020 who underwent endoscopic discectomy under local anesthesia. Follow-up was done using the visual analogue score (VAS) and Oswestry Disability Index (ODI) scoring systems with a minimum follow-up up to 1 year postoperatively. Results In our study of 60 patients, there was 38 cases of L4-L5 disc pathology, 13 L5-S1 discs, and 9 L3-L4 discs. Our study showed a significant clinical reduction in mean VAS score that was 7.07/10 preoperatively and reduced to 3.88/10 at the third month and 3.64/10 at 1 year of follow-up ( p -value < 0.05) showing clinical significance. The ODI scoring done preoperatively was an average mean of 57.37% pointing to how crippled the patients were with lumbar disc prolapse and showed a significant reduction to 29.32% postoperatively at 1 year ( p -value < 0.05) showing clinical significance. This reduction in ODI directly corelates to how almost all patients returned to normal life coping to all activities and were completely pain free at 1 year of follow-up. Conclusion Endoscopic spine surgery in lumbar disc prolapse is highly effective and can deliver a good functional outcome if done with correct preoperative planning and approach.
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Affiliation(s)
- Vishnu Vikraman Nair
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Sarabjeet Kohli
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Nilesh Vishwakarma
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Juilee Mhatre
- Department of Orthopaedics, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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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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Li H, Deng W, Wei F, Zhang L, Chen F. Factors related to the postoperative recurrence of lumbar disc herniation treated by percutaneous transforaminal endoscopy: A meta-analysis. Front Surg 2023; 9:1049779. [PMID: 36743903 PMCID: PMC9893773 DOI: 10.3389/fsurg.2022.1049779] [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: 09/21/2022] [Accepted: 11/04/2022] [Indexed: 01/21/2023] Open
Abstract
Objective To explore factors related to the postoperative recurrence of lumbar disc herniation treated by percutaneous transforaminal endoscopy. Methods PubMed, EMBASE, Cochrane Library, CNKI, Wanfang database and VIP database were systematically searched from the time of each library's construction to October 20, 2022. The studies that compared the influencing factors of recurrent lumbar disc herniation were included based on the PICO search structure. The Newcastle-Ottawa Scale was used to evaluate the quality of observational studies. The effects of the patient's age, gender, BMI, smoking, drinking, hypertension, diabetes, course of the disease, Pfirrmann grade, and the surgical segment on recurrent lumbar disc herniation were systematically evaluated using Revman 5.3. The odds ratio (OR) and 95% confidence interval (CI) were calculated. Results Thirteen studies involving 3,393 patients (323 patients with recurrent lumbar disc herniation) treated with percutaneous transforaminal endoscopy were included in this study. The results of the systematic evaluation showed that the effects of gender, smoking, drinking, hypertension, type of lumbar disc herniation and the surgical segment on recurrent lumbar disc herniation were not statistically significant. However, age ≥60 years (OR = 2.23; 95% CI: 1.13, 4.41), BMI ≥25 (OR = 2.89; 95% CI: 1.23, 6.80), diabetes (OR = 1.73; 95% CI: 1.18, 2.55), course of disease ≥4 years (OR = 2.93; 95% CI: 1.58, 5.43), Pfirrmann grades 3-4 (OR = 3.10; 95% CI: 2.18, 4.40), incomplete removal of nucleus pulposus (OR = 3.26; 95% CI: 1.69, 6.27) and intraoperative fibre breakage (OR = 3.18; 95% CI: 1.56, 6.50) increased the risk of recurrence after treatment. Conclusion The recurrence of lumbar disc herniation after percutaneous transforaminal endoscopic treatment is related to demographic characteristics, disease history and surgical conditions. In the future, more high-quality studies are needed to explore the influencing factors of recurrent lumbar disc herniation.
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Kravtsov MN, Manukovsky VA, Mirzametov SD, Malysheva OV, Averyanov DA, Svistov DV. Percutaneous Transforaminal Full-Endoscopic Removal of Neurinoma of the Fifth Lumbar Nerve Root With Intraoperative Neuromonitoring: A Case Report. Front Surg 2022; 9:877974. [PMID: 35574561 PMCID: PMC9098990 DOI: 10.3389/fsurg.2022.877974] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/29/2022] [Indexed: 11/29/2022] Open
Abstract
Background Technical achievements and surgical techniques improvement contribute to the expansion of the endoscopic spine surgery possibilities. However, today there are few reports about the use of percutaneous endoscopy in spinal tumor surgery. A case of percutaneous transforaminal endoscopic removal of the lumbar spinal nerve tumor with intraoperative neuromonitoring is presented. Case Description A 59-year-old female was complaining of a left shin and foot pain, weakness, and paresthesia. Preoperative magnetic resonance imaging (MRI) revealed a tumor (neurinoma) at the left L5-S1 intervertebral foramen. Transforaminal endoscopic removal of an extramedullary tumor from an 8-mm skin incision with intraoperative neuromonitoring was performed. Postoperative MRI revealed the signs of total resection of the tumor. Conclusion The presented case confirms that percutaneous endoscopic removal of lumbar spine intraforaminal neurinomas can be safe and effective.
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Affiliation(s)
- Maxim N. Kravtsov
- Kirov Military Medical Academy, St. Petersburg, Russia
- Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
- North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia
- *Correspondence: Maxim N. Kravtsov
| | - Vadim A. Manukovsky
- Saint-Petersburg I.I. Dzhanelidze Research Institute of Emergency Medicine, St. Petersburg, Russia
- North-Western State Medical University Named After I.I. Mechnikov, St. Petersburg, Russia
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Jiang Y, Yin J, Nong L, Xu N. Uniportal Full-Endoscopic versus Minimally Invasive Decompression for Lumbar Spinal Stenosis: A Meta-analysis. J Neurol Surg A Cent Eur Neurosurg 2022; 83:523-534. [PMID: 34991170 DOI: 10.1055/s-0041-1739208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In this study, we systematically analyze the effectiveness of the uniportal full-endoscopic (UPFE) and minimally invasive (MIS) decompression for treatment of lumbar spinal stenosis patients. METHODS We performed a systematic search in Medline, Embase, Europe PMC, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, China national knowledge infrastructure, and Wanfang Data databases for all relevant studies. All statistical analyses were performed using Review Manager version 5.3. RESULTS A total of 9 articles with 522 patients in the UPFE group and 367 patients in the MIS group were included. The results of the meta-analysis showed that the UPFE group had significantly better results in hospital stay time (mean difference [MD]: -2.05; 95% confidence interval [CI]: -2.87 to -1.23), intraoperative blood loss (MD: -36.56; 95% CI: -54.57 to -18.56), and wound-related complications (MD: -36.56; 95%CI: -54.57 to -18.56) compared with the MIS group, whereas the postoperative clinical scores (MD: -0.66; 95%CI: -1.79 to 0.47; MD: -0.75; 95%CI: -1.86 to 0.36; and MD: -4.58; 95%CI: -16.80 to 7.63), satisfaction rate (odds ratio [OR] = 1.24; 95%CI: 0.70-2.20), operation time (MD: 30.31; 95%CI: -12.55 to 73.18), complication rates for dural injury (OR = 0.60; 95%CI: 0.29-1.26), epidural hematoma (OR = 0.60; 95%CI: 0.29-1.26), and postoperative transient dysesthesia and weakness (OR = 0.73; 95%CI: 0.36-1.51) showed no significant differences between the two groups. CONCLUSIONS The UPFE decompression is associated with shorter hospital stay time and lower intraoperative blood loss and wound-related complications compared with MIS decompression for treatment of lumbar spinal stenosis patients. The postoperative clinical scores, satisfaction rate, operation time, complication rates for dural injury, epidural hematoma, and postoperative transient dysesthesia and weakness did not differ significantly between two groups.
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Affiliation(s)
- Yuqing Jiang
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Jianjian Yin
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Luming Nong
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou No.2 People's Hospital with Nanjing Medical University, Changzhou, China
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Castilho CAG, Guareschi Junior R, Meyer OD, Zylbersztejn S, Bello CD, Rodrigues NR, Loss F, Kisaki Y. PAIN INTENSITY AND FUNCTIONAL STATUS 30 DAYS AFTER SURGERY: DIFFERENCE BETWEEN TRANSFORAMINAL AND INTERLAMINAR PERCUTANEOUS ENDOSCOPICLUMBAR DISCECTOMIES. COLUNA/COLUMNA 2022. [DOI: 10.1590/s1808-185120222101259450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: To compare the differences between transforaminal and interlaminar endoscopic approaches in terms of pain intensity and functionality 30 days after the surgical procedure. Methods: A retrospective cohort study, with patients treated by percutaneous interlaminar or transforaminal endoscopic discectomy at the Spine Service of the ISCMPA, in southern Brazil. Data were collected from the patients’ electronic medical records by two independent physicians. The clinical outcomes of pain intensity and lumbar functionality were evaluated, respectively, using the visual analogue scale and the Oswestry Disability Index. Results: Thirty-six patients were included in the study, with a mean age of 50.8 ± 15.3 years, 19 (52.8%) of whom were males. As for the clinical outcomes for both transforaminal and interlaminar percutaneous endoscopic approaches, we observed a statistically significant reduction in pain intensity (mean difference of 3.5 points, p < 0.001) and a statistically significant improvement in functionality (mean difference of 33.2 points, p < 0.001) when we compared the pre- and 30-day postoperative periods, with no significant differences in terms of approaches. The type of technical approach also differed in relation to the patients’ age, the location, type, and migration of the herniated disc, and the patient’s time in the operating room. Conclusion: There was a similar effect on pain reduction and restoration of lumbar functions, 30 days after percutaneous endoscopic discectomy, in both technical approaches, with no significant differences between them. Level of Evidence III; Retrospective comparative study.
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Affiliation(s)
| | | | | | | | | | | | - Felipe Loss
- Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
| | - Yorito Kisaki
- Complexo Hospitalar Santa Casa de Porto Alegre, Brazil
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12
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Wu TL, Yuan JH, Jia JY, He DW, Miao XX, Deng JJ, Cheng XG. Percutaneous Endoscopic Interlaminar Discectomy via Laminoplasty Technique for L 5 -S 1 Lumbar Disc Herniation with a Narrow Interlaminar Window. Orthop Surg 2021; 13:825-832. [PMID: 33724665 PMCID: PMC8126925 DOI: 10.1111/os.12978] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To improve the treatment effect of patients with L5 S1 lumber disc herniation (LDH) with a narrow interlaminar window, we proposed an alternative approach to percutaneous endoscopic interlaminar discectomy (PEID) via the laminoplasty technique. METHODS Fifteen L5 S1 LDH patients (7 men and 8 women; age range, 22 to 56 years; median age, 34 years; 9 left, 6 right) were enrolled in the present study retrospectively. The interlaminar windows of all patients were narrow (the transverse diameter of the L5 S1 interlaminar window is equal to or less than that of L4-5 ). Percutaneous laminoplasty and endoscopic interlaminar discectomy surgery were undergone by all patients from July 2018 to July 2019. All operations were completed under local anesthesia. The target laminoplasty area was the safety zone, use of which avoids both transverse and exit nerve roots. Under fluoroscopic guidance or clear endoscopic visualization, the trephines were used to enlarge the interlaminar window, which allowed the working cannula to enter the spinal canal but avoid nerve roots and the dural sac. The preoperative/postoperative visual analogue scale (VAS) scores and Oswestry disability index (ODI) were statistically analyzed. The modified MacNab criterion was used to assess the clinical effects. The radiological outcomes were evaluated by MRI and CT. SPSS 19.0 software was used for the statistical evaluation. RESULTS The operative time ranged from 70 to 120 min, with a median time of 92 min, and the fluoroscopy times ranged from 8 to 12, with a median of 9.7 times. The body mass index (BMI) of patients ranged from 18.10 to 26.06, with a median of 22.04. All patients were followed up in the outpatient department for at least 12 months after surgery. At the last follow up, the average VAS-Back score of the study patients was reduced from 5.33 ± 2.09 to 2.00 ± 1.20 (P < 0.001) and the average VAS-Leg score was reduced from 7.53 ± 1.69 to 1.47 ± 0.92 (P < 0.001). The average ODI scores improved from 47.87 ± 11.41 to 12.93 ± 3.24 (P < 0.01). According to the modified MacNab criteria, 11 cases achieved excellent results and 4 cases achieved good results. All of the operations were successful. There wertr no nerve root injuries, dural tears, or other complications. CONCLUSION The laminoplasty approach for PEID provides a safe and useful alternative for the treatment of L5-S1 LDH patients with a narrow interlaminar window.
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Affiliation(s)
- Tian-Long Wu
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopaedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopaedics of Nanchang University, Nanchang, China
| | - Jing-Hong Yuan
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopaedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopaedics of Nanchang University, Nanchang, China
| | - Jing-Yu Jia
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopaedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopaedics of Nanchang University, Nanchang, China
| | - Ding-Wen He
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Minimally Invasive Orthopaedics of Nanchang University, Nanchang, China
| | - Xin-Xin Miao
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jian-Jian Deng
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Xi-Gao Cheng
- Department of Orthopaedics, The Second Affiliated Hospital of Nanchang University, Nanchang, China.,Institute of Orthopaedics of Jiangxi Province, Nanchang, China.,Institute of Minimally Invasive Orthopaedics of Nanchang University, Nanchang, China
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Elkheshin SE, Soliman AY. Endoscopic interlaminar lumbar discectomy: How to decrease the learning curve. Surg Neurol Int 2020; 11:401. [PMID: 33274114 PMCID: PMC7708962 DOI: 10.25259/sni_588_2020] [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] [Received: 08/28/2020] [Accepted: 10/28/2020] [Indexed: 11/24/2022] Open
Abstract
Background: Herniated lumbar disc is a common cause of lumbosacral pain. Endoscopic interlaminar lumbar discectomy (ILD) is a well-established technique that provided comparable results to micro-discectomy. The aim of the study is to describe the learning curve of endoscopic ILD and explore measures that could improve effectiveness and decrease blood loss and operative time with accumulation of reasonable experience. Methods: This retrospective cohort study included 65 patients presenting with symptomatic herniated lumbar disc who underwent endoscopic ILD. Patients were divided into two groups: Group I (standard technique) and Group II (modified technique). Collected data included patients’ age, gender, preoperative manifestations, visual analog score (VAS) for pain, Oswestry Disability Index (ODI), disc level, operative time, intraoperative blood loss, complications, and follow-up data at 1, 6, and 12 months postoperatively. Primary outcomes included total operative time, amount of intraoperative blood loss, and post-operative improvement in pain. Secondary outcomes included intraoperative complications, rate of conversion to open surgery, and recurrence. Results: Post-operative VAS and ODI improved significantly in both groups. Mean total surgical time and intraoperative blood loss were significantly lower in Group II compared to Group I (P < 0.001). The learning curves for operative time and intraoperative blood loss were shallow in Group I, and almost flattened in Group II. Complications were recorded in only three cases, and no symptomatic recurrences were reported. Conclusion: The learning curve of endoscopic ILD was shallow with standard technique, indicating difficulties in mastering the procedure. The proposed modified technique helped reaching the required level of proficiency in the early phase of the curve, providing a significant reduction in operative time and blood loss, with comparable effectiveness and safety as the standard technique.
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Affiliation(s)
| | - Ahmed Y Soliman
- Department of Neurosurgery, Faculty of Medicine, Tanta University, Tanta, Gharbia, Egypt
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Degenerative central lumbar spinal stenosis: is endoscopic decompression through bilateral transforaminal approach sufficient? BMC Musculoskelet Disord 2020; 21:714. [PMID: 33129294 PMCID: PMC7603715 DOI: 10.1186/s12891-020-03722-3] [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: 05/05/2020] [Accepted: 10/15/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND At present, few reports of percutaneous endoscopic transforaminal decompression surgery have been reported to solve central lumbar spinal stenosis (CLSS). Is endoscopic decompression through bilateral transforaminal approach decompression sufficient for degenerative CLSS? METHODS This retrospective study included 47 cases of CLSS patients who underwent percutaneous endoscopic decompression through bilateral transforaminal approach. Clinical outcomes such as ODI, back and leg VAS, the Macnab criteria were evaluated. Surgical results including operative time, postoperative hospital stay, recurrence, and surgical complications were also studied. Radiologically, lumbar stability was assessed and lumbar dural sac dimension was compared preoperatively and postoperatively. RESULTS All 47 patients were followed up. The average follow-up period was 24.5 months. The average operation time was 116 min. The mean VAS of leg and back pain, and the mean ODI improved from 7.81, 2.53, and 77.03% at baseline to a final 1.94 (P = 0.00), 2.47 (P = 0.71), and 19.40% (P = 0.00), respectively. According to the Macnab criteria, 97.9% of patients achieved excellent and good results. There were 2 cases of dural tear and 3 cases of transient postoperative dysthesia. The cross-sectional area of the dural sac was significant enlargement at the last fellow up (74.28 ± 13.08 mm2 vs.104.91 ± 12.40 mm2, P = 0.00). CONCLUSIONS Except for the main pathogenic factors on the dorsal side of the dural sac, percutaneous endoscopic decompression through a bilateral transforaminal approach is sufficient for CLSS. It is a feasible, safe, and clinically effective minimally invasive procedure.
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Yin J, Jiang Y, Nong L. Transforaminal approach versus interlaminar approach: A meta-analysis of operative complication of percutaneous endoscopic lumbar discectomy. Medicine (Baltimore) 2020; 99:e20709. [PMID: 32569205 PMCID: PMC7310843 DOI: 10.1097/md.0000000000020709] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND To systematically analyze the differences of complications between percutaneous transforaminal endoscopic discectomy (PTED) and percutaneous interlaminar endoscopic discectomy (PIED) in the treatment of lumbar disc herniation. METHODS We performed a systematic search in MEDLINE, EMBASE, PubMed, Web of Science, Cochrane databases, Chinese Biomedical Literature Database, CNKI, and Wanfang Data for all relevant studies. All statistical analysis was performed using Review Manager Version 5.3. RESULTS A total of 15 articles with 1156 study subjects were included, with 550 patients in PTED group and 606 patients in PIED group. The results of the meta-analysis showed that postoperative dysesthesia (odds ratio [OR] = 0.61, 95% confidence interval [CI], 0.33-1.13), nerve root injury (OR = 1.22, 95% CI, 0.30-5.02), surgical site wound complications (OR = 1.26, 95% CI, 0.29-5.40), recurrence (OR = 1.09, 95% CI, 0.54-2.21), conversion to open surgery (OR = 1.26, 95% CI, 0.33-4.81), incomplete decompression (OR = 1.62, 95% CI, 0.43-6.09), and total complication (OR = 0.72, 95% CI, 0.49-1.06) showed no significant differences between the PTED group and the PIED group, while the PTED group had significantly better results in dural tear compared with the PIED group (OR = 0.31, 95% CI, 0.13-0.79). CONCLUSIONS Dural tear was significantly less occured in PTED compared with PIED. The postoperative dysesthesia, nerve root injury, surgical site wound complications, recurrence, conversion to open surgery, incomplete decompression, and total complication did not differ significantly between PTED and PIED in the treatment of lumbar disc herniation.
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Cheng L, Cai H, Liu Z, Yu Y, Li W, Li Q. Modified Full-Endoscopic Interlaminar Discectomy via an Inferior Endplate Approach for Lumbar Disc Herniation: Retrospective 3-Year Results from 321 Patients. World Neurosurg 2020; 141:e537-e544. [PMID: 32492545 DOI: 10.1016/j.wneu.2020.05.234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 05/24/2020] [Accepted: 05/25/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure that shows satisfying outcomes for the treatment of L5-S1 and even L4-5 disc herniation. PEID can be divided into direct and indirect approaches according to the established method of the working channel. The direct approach mainly uses the puncture needle directly through the intervertebral space into the intervertebral disc under indirect vision and insertion of the guidewire into the puncture needle to guide the dilator and into the working channel to retract the ligamentum flavum, dural sac, and nerve roots. This approach requires a skilled puncture technique, given the high risk of damage to the nerve roots and dural sac. Therefore, we improved this interlaminar access procedure, placing the puncture target at the inferior endplate and performing preoperative epidurography to expose the spinal nerve roots and dural sac after the puncture needle was passed through the ligamentum flavum. We then positioned the puncture needle at the posterior edge of the superior centrum. Finally, we inserted the working sleeve for the operation. This approach is convenient and effectively reduces the learning curve and intraoperative complications. Here we introduce the procedure and report the safety and efficacy of full-endoscopic interlaminar discectomy via an inferior endplate approach for the treatment of lumbar disc herniation. METHODS We performed full-endoscopic interlaminar discectomy via the inferior endplate approach in 321 patients who met our inclusion criteria between May 2014 and May 2017. All operations were completed under local anesthesia. Under fluoroscopic guidance, we performed epidurography to expose the spinal nerve roots and dural sac. The working sleeve and endoscope were then introduced into the inferior endplate of the superior centrum. Herniated disc material was removed using forceps and a laser under clear endoscopic visualization. We retrospectively evaluated the 321 patients with more than 30 months (range, 12-48 months) of follow-up. The therapeutic effects were assessed using scores of the visual analog scale (VAS), Oswestry disability index (ODI), Macnab standard, and infrared thermal imaging. RESULTS The mean VAS score for radicular pain improved from 6.3 ± 1.01 preoperatively to 1.01 ± 0.35 at the final follow-up (P < 0.01). The mean ODI score improved from 85.5 ± 12 preoperatively to 12.4 ± 3.7 at the final follow-up (P < 0.01). According to the MacNab standard, the excellent and good outcome scores were 96.5%. The infrared thermal imaging scores indicated significantly improved skin temperature of both lower extremities at 1 week after surgery compared with the preoperation temperature (P < 0.01). CONCLUSIONS The inferior endplate approach for percutaneous endoscopic interlaminar discectomy provides a safe and effective alternative for the treatment of lumbar disc herniation.
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Affiliation(s)
- Liang Cheng
- Department of Spine Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Heguo Cai
- Department of Orthopedics, The Third Hospital of Xiamen, Xiamen, China
| | - Zhongguo Liu
- Department of Orthopedics, The Third Hospital of Xiamen, Xiamen, China
| | - Yuyu Yu
- Department of Pain Medicine, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Weixing Li
- Department of Pain Medicine, The Fifth People's Hospital of Dongguan, Dongguan, China
| | - Qingchu Li
- Department of Spine Surgery, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China.
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Chen X, Xu G, Hu Q, Zhao T, Bi Q, Huang Y, Shao H, Zhang J. Percutaneous transforaminal endoscopic decompression for the treatment of intraspinal tophaceous gout: A case report. Medicine (Baltimore) 2020; 99:e20125. [PMID: 32481280 PMCID: PMC7249926 DOI: 10.1097/md.0000000000020125] [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: 11/26/2022] Open
Abstract
RATIONALE Intraspinal tophaceous gout is relatively rare condition presenting with major clinical manifestations, such as spinal cord or nerve roots compressions (radiculopathy). It is usually difficult to differentiate intraspinal tophaceous gout, lumbar disc herniation, stenosis of spinal canal, ossification of ligamentum flavum, and other degenerative spinal disorders from each other. PATIENT CONCERNS A 64-year-old man was admitted with a history of progressive low back pain for 11 months. He also presented with radiculopathy and numbness of his left lower extremity. DIAGNOSES Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) showed L4/5 disc herniation and lateral recess stenosis on the left side. During the operation of percutaneous transforaminal endoscopic decompression, intraspinal chalky white material was seen. Post-operative pathologic results confirmed the diagnosis of gouty tophi. INTERVENTIONS Percutaneous transforaminal endoscopic decompression was performed as treatment. Intraspinal chalky white material was seen. We removed most of the chalky white material and extruded nucleus. OUTCOMES His symptom subsided rapidly and no deterioration was noted 1 year post-operatively. LESSONS Although intraspinal tophaceous gout is not commonly seen, clinicians should take it into consideration as a possible differential diagnosis when the patient exhibits axial pain or neurological deficits with risk factors of gout. We identified and treated this case with percutaneous transforaminal endoscopic decompression for the first time and got an excellent outcome. Percutaneous transforaminal endoscopic surgery proved to be an effective and minimally invasive alternative for identifying and treating intraspinal tophaceous gout.
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Affiliation(s)
- Xinji Chen
- Department of Orthopedics, Zhejiang Provincial People's Hospital
- Hangzhou Medical College People's Hospital, Hangzhou
- School of Clinical Medicine, Wenzhou Medical College, Wenzhou, Zhejiang
| | - Guokang Xu
- Department of Orthopedics, Fuyang First People's Hospital
| | - Qingfeng Hu
- Department of Orthopedics, The Affiliated Guang-Xing Hospital of Zhejiang TCM University, Hangzhou, Zhejiang
| | - Tingxiao Zhao
- Department of Orthopedics, Zhejiang Provincial People's Hospital
- Hangzhou Medical College People's Hospital, Hangzhou
- Bengbu Medical College, Bengbu, Anhui, China
| | - Qing Bi
- Department of Orthopedics, Zhejiang Provincial People's Hospital
- Hangzhou Medical College People's Hospital, Hangzhou
| | - Yazeng Huang
- Department of Orthopedics, Zhejiang Provincial People's Hospital
- Hangzhou Medical College People's Hospital, Hangzhou
| | - Haiyu Shao
- Department of Orthopedics, Zhejiang Provincial People's Hospital
- Hangzhou Medical College People's Hospital, Hangzhou
| | - Jun Zhang
- Department of Orthopedics, Zhejiang Provincial People's Hospital
- Hangzhou Medical College People's Hospital, Hangzhou
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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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Zelenkov P, Nazarov VV, Kisaryev S, Pimenova L, Zakirov BA, Goldberg M, Konovalov NA, Feniksov V, Kondrashov A, Popov I, Zagirov RI. Learning Curve and Early Results of Interlaminar and Transforaminal Full-Endoscopic Resection of Lumbar Disc Herniations. Cureus 2020; 12:e7157. [PMID: 32190523 PMCID: PMC7053674 DOI: 10.7759/cureus.7157] [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] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Full-endoscopic spinal surgery is an evolving technique. A laborious learning phase is inevitable due to the complexity of the orientation and instrumentation. The goal of the present study is to evaluate a single surgeon’s learning curve and early outcomes in full-endoscopic resection of lumbar disc herniations. Methods This was a prospective non-controlled single-surgeon cohort study. In 54 patients with 57 herniations, 41 interlaminar and 16 transforaminal resections were performed. Surgery time, severity of adhesive process in the spinal canal, complication rates and clinical outcomes (VAS, ODI, custom questionnaire, recurrence and re-operation rate) were assessed. Results In the interlaminar group, operative time has decreased from 60 ± 20 min in the first 20 operations to 45 ± 14 min in the following 17 (p=0.023). In the transforaminal group, operative time has decreased from 60 ± 16 min in the first 7 operations to 41 ± 12 min in following 9 (p=0.023). Severe adhesive process in spinal canal was associated with duration of symptoms greater than 2 years, longer surgery and higher risk of surgical complications. Four recurrent disc herniations were re-operated using full-endoscopic technique. VAS, ODI and pain medications significantly decreased in both groups and in re-operated patients. Conclusion The plateau of the learning curve and good short-term clinical results of full-endoscopic interlaminar and transforaminal surgery may be achieved after twenty operations, given extensive previous experience in microsurgery. Risk of complications at the learning phase may be decreased by excluding the patients with symptoms lasting over two years.
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Affiliation(s)
- Petr Zelenkov
- Spinal Neurosurgery, N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, RUS
| | - Vyacheslav V Nazarov
- Neurosurgery, N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, RUS
| | - Sergey Kisaryev
- Neurosurgery, Gerzen Research Oncological Center, Moscow, RUS
| | | | - Bahrom A Zakirov
- Neurosurgery, N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, RUS
| | - Maria Goldberg
- Neurosurgery, First Moscow State Medical University, Moscow, RUS
| | - Nikolay A Konovalov
- Spinal Neurosurgery, N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, RUS
| | - Viktor Feniksov
- Neurosurgery, Moscow Regional Medical Research Center, Moscow, RUS
| | | | - Ilya Popov
- Neurosurgery, Moscow State Hospital, Moscow, RUS
| | - Ruslan I Zagirov
- Radiosurgery, N.N. Burdenko National Medical Research Center for Neurosurgery, Moscow, RUS
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Wasinpongwanich K, Pongpirul K, Lwin KMM, Kesornsak W, Kuansongtham V, Ruetten S. Full-Endoscopic Interlaminar Lumbar Discectomy: Retrospective Review of Clinical Results and Complications in 545 International Patients. World Neurosurg 2019; 132:e922-e928. [DOI: 10.1016/j.wneu.2019.07.101] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
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Telfeian AE, Shen J, Ali R, Oyelese A, Fridley J, Gokaslan ZL. Incidence and Implications of Incidental Durotomy in Transforaminal Endoscopic Spine Surgery: Case Series. World Neurosurg 2019; 134:e951-e955. [PMID: 31734429 DOI: 10.1016/j.wneu.2019.11.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. METHODS Transforaminal lumbar endoscopic procedures were performed by 2 surgeons in 907 patients over a period of 4 years from 2014 to 2018. Patient data were evaluated retrospectively in these patients with a minimum follow-up of 1 year. RESULTS In 907 patients over 4 years there were 5 durotomies: 4 incidental and 1 intentional. The rate for incidental durotomy was therefore 0.4%. There were no adverse outcomes from the incidental durotomies, and only 1 patient noted a headache. CONCLUSIONS Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.
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Affiliation(s)
- Albert E Telfeian
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
| | - Jian Shen
- Mohawk Valley Orthopedics, Amsterdam, New York, USA
| | - Rohaid Ali
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Adetokunbo Oyelese
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Jared Fridley
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ziya L Gokaslan
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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Mixed Reality-Based Preoperative Planning for Training of Percutaneous Transforaminal Endoscopic Discectomy: A Feasibility Study. World Neurosurg 2019; 129:e767-e775. [PMID: 31203062 DOI: 10.1016/j.wneu.2019.06.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To explore the effect of preoperative planning using mixed reality (MR) on training of percutaneous transforaminal endoscopic discectomy (PTED). METHODS Before the training, we invited an experienced chief physician to plan the puncture path of PTED on the X-ray films of the lumbar spine model and the 3D Slicer platform, respectively, and used this as the standard to guide trainees. In the aggregate, 60 young residents were randomly divided into Group A (N = 30) and Group B (N = 30). Group A learned the 2-dimensional standard planning route, whereas Group B learned the standard route planning based on MR through the 3D Slicer platform. Then, trainees were asked to conduct PTED puncture on a lumbar spine model. Questionnaires were distributed to trainees before and after the training. During the training, puncture times, operating time (minutes), and fluoroscopy times were recorded. RESULTS After the training, it was obvious that more trainees showed their recognition of MR, believing that MR could help preoperative planning and training of PTED. Their high satisfaction with the training indicated the success of our training. Moreover, puncture times, operating time (minutes), and fluoroscopy times of Group B were significantly lower than those of Group A. CONCLUSIONS MR technology contributes to preoperative planning of PTED and is beneficial in the training of PTED. It significantly reduces puncture times and fluoroscopy times, providing a standardized method for the training of PTED.
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Ren Z, Li Z, Li S, Xu D, Chen X. Small incision discectomy for lumbar disc herniation in 98 patients with 5-year follow-up: A retrospective case series study. Medicine (Baltimore) 2019; 98:e15569. [PMID: 31083228 PMCID: PMC6531178 DOI: 10.1097/md.0000000000015569] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Optimal surgical technique to treat lumbar disc herniation (LDH) remains controversial. We described a small incision discectomy technique (SID), and to evaluate its safety and efficacy. A retrospective study involving 98 consecutive patients with LDH managed by SID was conducted. All patients were followed up for 5 years. Outcomes included visual analogue scale (VAS), Japanese Orthopedic Association (JOA), operative time, length of incision, blood loss, hospital stay, hospitalization costs, x-ray exposure, reoperation, and complications. The results were determined to be excellent, good, fair, or poor according to the MacNab classification. All patients completed the 5-year follow-up. Relative to preoperative scores, VAS and JOA were both significantly improved. As a whole, 93.8% (92/98) patients showed excellent or good results, 3.1% (3/98) fair, and 3.1% (92/98) poor. The operation time, length of incision, blood loss, and hospital stay were 50 ± 11.1 minutes, 2.2 ± 0.3 cm, 35 ± 3.5 mL, and 4.3 ± 0.2 days, respectively. Additionally, compared with previous literature reports, the hospitalization costs and x-ray exposure were apparently less. The reoperation and recurrence rate were 3.2% and 2.1%. No complications were observed. From these data we conclude that SID appears to be a safe, cost-effective technique for LDH, and has lower x-rays exposure time when compared with literature of percutaneous endoscopic lumbar discectomy (PELD).
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Affiliation(s)
- Zhinan Ren
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing
- Department of Orthopaedics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zheng Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing
| | - Shugang Li
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing
| | - Derong Xu
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing
| | - Xin Chen
- Department of Orthopaedics, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Dongcheng District, Beijing
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Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: a meta-analysis. DER ORTHOPADE 2019; 49:338-349. [PMID: 30989258 DOI: 10.1007/s00132-019-03710-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this study was to systematically compare the safety and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of lumbar disc herniation (LDH). MATERIAL AND METHODS All studies that were performed to compare PETD with PEID to treat LDH and published until 31 August 2017 were acquired through a comprehensive search in various databases. A meta-analysis was performed using the Cochrane Collaboration's RevMan 5.3 software. RESULTS A total of 13 trials with 974 cases consisting of 3 randomized controlled trials, 3 prospective studies and 7 retrospective studies were included. The results suggest that patients treated with PEID experienced more significant advantages with shorter operation time, less intraoperative blood loss and less intraoperative fluoroscopy times but more complications than those treated with PETD; however, the two operative approaches did not significantly differ in terms of LDH recurrence, hospital stay, Oswestry disability index (ODI) scores, visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores and MacNab criteria at the final follow-up. CONCLUSION Based on the results of this study, although PEID may be superior to PETD in certain ways, some of its advantages have yet to be verified and the two interventions were not significantly different in terms of relief of symptoms and functional recovery. Therefore, PEID would be recommended for treating LDH especially at L5/S1 under certain conditions but a prudent attitude is necessary to choose between the two operative approaches before a large sample and high quality randomized controlled trials have been performed.
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Yoo Y, Moon JY, Yoon S, Kwon SM, Sim SE. Clinical outcome of percutaneous lumbar foraminoplasty using a safety-improved device in patients with lumbar foraminal spinal stenosis. Medicine (Baltimore) 2019; 98:e15169. [PMID: 30985699 PMCID: PMC6485750 DOI: 10.1097/md.0000000000015169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Lumbar foraminal spinal stenosis (LFSS) is defined as the narrowing of the nerve root exit associated with a herniated intervertebral disc, osteoarthritic changes in the facet joints, or a hypertrophied ligamentum flavum, which can provoke neurogenic claudication. To achieve effective and safe decompression of the lumbar spinal foramen, a specially designed instrument (Claudicare, SEAWON Meditech, Bucheon-si, Gyeonggi-do, Republic of Korea) for percutaneous lumbar foraminoplasty (PLF) was invented. The purpose of this study was to evaluate the clinical efficacy and safety of the newly devised instrument in patients with LFSS.PLF was performed for LFSS by a single pain physician. For each patient, an 11-point numerical rating scale (NRS) pain score-the Oswestry Disability Index (ODI)-and the duration of walking without radicular pain were evaluated at the 3-month follow-up. The successful responder percentage was defined as ≥50% reduction from the baseline NRS score with improvement in ODI and duration of walking.Among 24 patients who underwent PLF, 15 patients showed successful responses. The NRS pain score and duration of walking without radicular pain were improved significantly from baseline at the 3-month follow-up (P < .01). The ODI was also decreased, but the difference was not statistically significant (P = .09). The NRS pain score and walking duration without pain at 3 months were statistically significantly different between the groups (P < .001 and P = .01, respectively), whereas there was no statistically significant difference in improvement in ODI between the groups (P = .23). No serious adverse events occurred in the study.In conclusion, PLF using the Claudicare device may be an optimal and safe option for managing intractable LFSS on an outpatient basis.
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Affiliation(s)
- Yongjae Yoo
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
- Integrated Cancer Management Center, Seoul National University Cancer Hospital
| | - Sojeong Yoon
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center
| | - Seok Min Kwon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital
- Department of Anesthesiology and Pain Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center
| | - Sung Eun Sim
- Department of Anesthesiology and Pain Medicine, The Catholic University of Korea, Seoul ST. Mary's Hospital, Seoul, Republic of Korea
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Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up. Pain Res Manag 2019; 2019:6924941. [PMID: 30719201 PMCID: PMC6334377 DOI: 10.1155/2019/6924941] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 11/29/2018] [Indexed: 12/19/2022]
Abstract
Background Both transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty (TF PELF) and transforaminal percutaneous endoscopic lumbar discectomy without foraminoplasty (TF PELD) were developed for lumbar disc herniation (LDH) patients. However, the safety and effectiveness between the TF PELF and TF PELD have not been investigated. Methods Of the included 140 LDH patients, 62 patients received TF PELF (PELF group) and 78 patients received TF PELD (PELD group). The operation time, the duration of staying at the hospital, and complication incidences were recorded. All patients were followed up for 2 years, where low back and leg visual analogue scale (VAS) pain ratings and Oswestry Disability Index (ODI) were compared between the 2 groups before and after surgery. Modified Macnab criterion was estimated for all patients at postoperative 2 years. Results There were no significant difference of the operation time, number of days staying at the hospital, and the incidence of complications between the 2 groups (P > 0.05). Two cases in the PELF group and 1 case in the PELD group received a second surgery due to unrelieved symptoms postoperatively. Low back and leg VAS and ODI scores decreased in both groups after operation (P < 0.01), respectively, but were not significant between the 2 groups over time (P > 0.05). Six patients in the PELF group and 3 patients in the PELD group did not continue the follow-up; thus, only 131 patients completed Macnab evaluation. The satisfactory rate was reported as 80.4% in the PELF group and 90.7% in the PELD group (P > 0.05). Conclusions This study suggested that the safety and effectiveness of TF PELF are comparable to TF PELD for LDH patients.
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Double-Layer TachoSil Packing for Management of Incidental Durotomy During Percutaneous Stenoscopic Lumbar Decompression. World Neurosurg 2018; 120:448-456. [DOI: 10.1016/j.wneu.2018.09.040] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 11/22/2022]
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Hua W, Zhang Y, Wu X, Gao Y, Li S, Wang K, Zeng X, Yang S, Yang C. Outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar and transforaminal approaches in the treatment of L5-S1 disc herniation: An observational study. Medicine (Baltimore) 2018; 97:e13456. [PMID: 30508967 PMCID: PMC6283137 DOI: 10.1097/md.0000000000013456] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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
The purpose of this retrospective study was to assess the clinical outcomes of discectomy by using full-endoscopic visualization technique via the interlaminar approach versus the transforaminal approach under general anesthesia in the treatment of L5-S1 disc herniation.Sixty patients with L5-S1 disc herniation were non-randomly recruited and assigned into two groups. One group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the interlaminar approach under general anesthesia, while the other group (thirty patients) underwent discectomy by using full-endoscopic visualization technique via the transforaminal approach under general anesthesia. The operative time, fluoroscopy time, and perioperative complications were recorded. The visual analog scale (VAS) score for leg and back pain and Oswestry disability index (ODI) score were evaluated preoperatively and at 3, 6, and 18 months postoperatively.The mean operative time and fluoroscopy time in the interlaminar group were significantly shorter compared with those in the transforaminal group. The mean VAS and ODI postoperative scores were significantly improved over the preoperative scores in both groups. According to the MacNab classification system, more than 90.0% of the patients achieved an excellence/good rating in both groups. An intraoperative epineurium injury occurred in both groups. The total recurrence rate during 18 months follow-up was 3.3% in the interlaminar group and 0% in the transforaminal group.It is efficient and safe to perform discectomy by using full-endoscopic visualization technique via both interlaminar and transforaminal approaches under general anesthesia in patients with L5-S1 disc herniation. Discectomy performed by using full-endoscopic visualization technique via the interlaminar approach requires a shorter operative time and suffers less radiation exposure than the transforaminal approach.
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Quillo-Olvera J, Akbary K, Lin GX, Kim JS. Delayed Infected Pseudomeningocele After Percutaneous Endoscopic Lumbar Diskectomy. World Neurosurg 2018; 119:315-320. [PMID: 30144597 DOI: 10.1016/j.wneu.2018.08.057] [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: 05/15/2018] [Revised: 08/08/2018] [Accepted: 08/10/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous endoscopic lumbar diskectomy (PELD) has evolved over the last decades and has become an effective treatment for soft disk herniations. However, while its use increases, newer complications have been discovered. CASE DESCRIPTION We present the unique case of a woman who underwent PELD/foraminotomy to treat right-side foraminal disk herniations on L4-5 and L5-S1 in the same procedure. Ten days after surgery, the patient developed fever and severe low back pain radiated down her right leg. Magnetic resonance imaging showed a right pseudomeningocele arising from L4-5 and a nerve root herniated through the dural sac at the same lumbar segment. Blood cultures and fluid culture obtained from pseudomeningocele drainage depicted infection. Specific antibiotics were administrated, direct dura repair under the microscope was performed, and the patient improved symptomatically. CONCLUSIONS PELD combined with foraminotomy is a relatively new and skill-demanding surgery which is indicated only in cases where foraminal disk herniation is combined with foraminal stenosis. This surgical strategy requires experience by the endoscopic surgeon to prevent procedure-related complications. Although rare, these complications can lead to increased morbidity.
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Affiliation(s)
- Javier Quillo-Olvera
- The Brain and Spine Care, Minimally Invasive Spine Surgery Center, Queretaro City, Mexico
| | - Kutbuddin Akbary
- Seoul St. Mary's Hospital, Spine Center, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Guang-Xun Lin
- Seoul St. Mary's Hospital, Spine Center, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Seoul St. Mary's Hospital, Spine Center, Department of Neurosurgery, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
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Fan G, Feng C, Yin B, Guan X, Fan Y, Zhu Y, Wang C, He S. Concentric Stereotactic Technique of Percutaneous Endoscopic Transforaminal Discectomy and Radiation Exposure to Surgeons. World Neurosurg 2018; 119:e1021-e1028. [PMID: 30142433 DOI: 10.1016/j.wneu.2018.08.051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE In percutaneous endoscopic transforaminal discectomy (PETD), surgeons are exposed to intraoperative radiographic radiation over a long-term career, which may be correlated with high risk of iatrogenic radiation hazards. The purpose of this prospective cohort study was to assess the impact of concentric stereotactic technique on radiation exposure to surgeons in PETD. METHODS Patients who underwent conventional PETD were regarded as group A, whereas those undergoing PETD with concentric stereotactic technique were considered as group B. The primary outcomes were cumulative radiation dose to the surgeon's eye, thyroid gland, and breast. RESULTS A total of 34 patients were treated in group A and 30 patients were treated in group B. The cumulative radiation dose of the eye per operation was 0.017 (0.58/34) mSv in group A and 0.010 (0.31/30) mSv in group B, which meant a reduction of 41.18%. The cumulative radiation dose of the thyroid gland per operation was 0.018 (0.60/34) mSv in group A and 0.011 (0.33/30) mSv in group B, which meant a reduction of 38.89%. The cumulative radiation dose of the chest per operation was 0.039 (1.33/34) mSv in group A and 0.023 (0.70/30) mSv in group B, which meant a reduction of 41.03%. There were no significant differences in hospital stay, visual analog scale score of waist and leg pain, Oswestry Disability Index score, MacNab satisfaction, and complications between the 2 groups (P > 0.05). CONCLUSIONS The concentric stereotactic technique can effectively reduce radiation exposure to surgeons by about 40%.
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Affiliation(s)
- Guoxin Fan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chaobo Feng
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bangde Yin
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaofei Guan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yunshan Fan
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yanjie Zhu
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chuanfeng Wang
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Shisheng He
- Orthopedic Department, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
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Percutaneous Endoscopic Treatment for a Symptomatic Sacral Tarlov Cyst. World Neurosurg 2018; 116:390-393. [DOI: 10.1016/j.wneu.2018.05.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 11/17/2022]
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Isocentric Navigation for the Training of Percutaneous Endoscopic Transforaminal Discectomy: A Feasibility Study. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6740942. [PMID: 30112415 PMCID: PMC6077558 DOI: 10.1155/2018/6740942] [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: 01/04/2018] [Accepted: 05/31/2018] [Indexed: 12/15/2022]
Abstract
Background Percutaneous endoscopic transforaminal discectomy (PETD) is usually chosen for lumbar disc herniation due to its obvious advantages such as small incision and absence of nerve or muscular traction. However, learning PETD is a great challenge for inexperienced surgeons. Objective The study aimed to investigate whether isocentric navigation would be beneficial in PETD training. Methods A total of 117 inexperienced surgeons were trained with PETD at L2/3, L3/4, L4/5, and L5/S1 on the cadavers without (Group A n=58) or with (Group B n=59) isocentric navigation. Puncture times, fluoroscopy times, exposure time, and radiation dose were recorded and analyzed. Questionnaires were conducted before and after the training program. Result Isocentric navigation could improve young surgeons' satisfaction with the training program and decrease the puncture times, fluoroscopy times, exposure time, and radiation dose significantly (P<0.001). Conclusion Isocentric navigation contributes to the training of PETD and may improve its standardization, homogenization, and generalization.
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Wu XD, Chen Y, Yu WC, Liu Y, Cao P, Tian Y, Wang XW, Chen HJ, Ye XJ, Yuan W, Yeung A. Effectiveness of Bi-Needle Technique (Hybrid Yeung Endoscopic Spine System/Transforaminal Endoscopic Spine System) for Percutaneous Endoscopic Lumbar Discectomy. World Neurosurg 2018; 119:e53-e59. [PMID: 29981910 DOI: 10.1016/j.wneu.2018.06.220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The bi-needle technique is a new technique for percutaneous endoscopic lumbar discectomy. This technique combines the advantages of Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) techniques. The aim of this study was to evaluate effectiveness of the bi-needle technique for percutaneous endoscopic lumbar discectomy and compare it with the TESSYS technique. METHODS We reviewed 86 patients with single-level lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy in our hospital from June 2013 to December 2015. Bi-needle technique was used in 49 patients (30 men, 19 women; average age 40.4 ± 5.2 years). TESSYS technique was used in 37 patients (19 men, 18 women; average age 42.8 ± 6.4 years). Clinical results were evaluated and compared between the 2 groups. RESULTS Symptoms in both groups were significantly improved at the last follow-up (P < 0.01). There was no statistical difference in visual analog scale and lumbar Japanese Orthopaedic Association scores between bi-needle and TESSYS groups at last follow-up (P = 0.69 and P = 0.33, respectively). Operative time was shorter in the bi-needle group (P < 0.01). Recurrence rate and reoperation rate were lower in the bi-needle group (P = 0.04 and P = 0.03, respectively). Discitis was diagnosed in 2 patients in the TESSYS group. There were no patients with postoperative discitis in the bi-needle group. CONCLUSIONS The bi-needle technique is safe and effective for treatment of lumbar disc herniation. Compared with TESSYS technique, operative time is shorter, and recurrence and reoperation rates are lower.
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Affiliation(s)
- Xiao-Dong Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yu Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen-Chao Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yang Liu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Peng Cao
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ye Tian
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xin-Wei Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hua-Jiang Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Xiao-Jian Ye
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Anthony Yeung
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Müller SJ, Burkhardt BW, Oertel JM. Management of Dural Tears in Endoscopic Lumbar Spinal Surgery: A Review of the Literature. World Neurosurg 2018; 119:494-499. [PMID: 29902608 DOI: 10.1016/j.wneu.2018.05.251] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 05/31/2018] [Indexed: 10/14/2022]
Abstract
OBJECTIVE The incidental dural tear is a common complication in lumbar spine surgery. It has been reported that the incidence of dural tears is much greater in endoscopic procedures. Primary closure via suturing remains challenging in endoscopic procedures. The objective of this study was to conduct a literature review on the surgical technique for dural closure and repair in endoscopic spine surgery. METHODS A systematic literature search was performed using the database PubMed. In total, 12 studies reported specifically about the surgical treatment for dural tear in percutaneous and tubular assisted endoscopic technique. The dural tear rate, the technique of dural closure, postoperative time of bed rest, postoperative symptoms related to cerebrospinal fluid fistula, and revision surgery were assessed. RESULTS The overall rate of dural tears in endoscopic spinal surgery was 2.7%, with a range from 0% to 8.6%. The incidence of a dural tear was much greater in cases with lumbar stenosis (3.7%) than in lumbar disc herniation (2.1%). The greatest rate was accompanied by resecting synovial cysts. In addition, the risk of dural tear is greater in bilateral decompression procedures via a unilateral approach. There is no consensus about the ideal technique for dural closure in endoscopic procedures. Furthermore, there is a debate whether dural tear requires surgical treatment or not. CONCLUSIONS An autologous muscle or fat graft in combination with fibrin glue or a fibrin-sealed collagen sponge seems to be a good and safe method for the management of dural tear in lumbar endoscopic spine surgery.
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Affiliation(s)
- Simon J Müller
- Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany
| | - Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Faculty of Saarland University, Homburg-Saar, Germany.
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Hua W, Tu J, Li S, Wu X, Zhang Y, Gao Y, Zeng X, Yang S, Yang C. Full-endoscopic discectomy via the interlaminar approach for disc herniation at L4-L5 and L5-S1: An observational study. Medicine (Baltimore) 2018; 97:e0585. [PMID: 29703053 PMCID: PMC5944510 DOI: 10.1097/md.0000000000010585] [Citation(s) in RCA: 11] [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: 12/02/2022] Open
Abstract
The purpose of this retrospective study was to investigate the clinical outcomes of full-endoscopic discectomy via the interlaminar approach in the treatment of lumbar disc herniation (LDH) at L4-L5 under general anesthesia.Eighty-four patients who underwent full-endoscopic discectomy via the interlaminar approach at L4-L5 or L5-S1 were included. Durations of surgery, intraoperative radiation, postoperative bedrest, and hospitalization as well as perioperative complications were recorded. The visual analog scale (VAS) score for leg and back pain and the Oswestry disability index (ODI) score were evaluated preoperatively and at 3, 6, and 12 months postoperatively.The mean durations of surgeries in surgeries involving L4-L5 and L5-S1 were 69.8 ± 18.8 and 67.0 ± 20.1 minutes, respectively. The mean durations of intraoperative radiation were 1.2 ± 0.3 and 1.3 ± 0.3 seconds, respectively. The mean VAS and ODI scores improved significantly postoperatively compared with the preoperative scores. The perioperative complications included intraoperative epineurium injury in 3 cases without nerve injury, cerebrospinal fluid leakage, or cauda equina syndrome. The total recurrence rate after 12 months follow-up was 1.2% (one case at L5-S1).Full-endoscopic discectomy via the interlaminar approach could be considered as one of the alternative options for the treatment of LDH at L4-L5.
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Abstract
STUDY DESIGN This is a cross-sectional study. OBJECTIVE The purpose of this study is to evaluate the content of information available on the Internet regarding minimally invasive spine surgery (MISS). SUMMARY OF BACKGROUND DATA Patients look to the Internet for quick and accessible information on orthopedic procedures to help guide their personal decision making process regarding the care they receive. However, the quality of internet-based orthopedic education material varies significantly with respect to accuracy and readability. MATERIALS AND METHODS The top 50 results were generated from each of 3 search engines (Google, Yahoo!, and Bing) using the search term "minimally invasive spine surgery." Results were categorized by authorship type and evaluated for their description of key factors such as procedural benefits, risks, and techniques. Comparisons between search engines and between authorship types were done using the Freeman-Halton extension for the Fisher exact test. The content of websites certified by Health on the Net Foundation (HONcode) was compared with those not HONcode certified. RESULTS Of the 150 websites and videos, only 26% were authored by a hospital or university, whereas 50% were by a private physician or clinic. Most resources presented some benefits of MISS (84%, 126/150), but only 17% presented risks of the procedure (26/150). Almost half of all resources described the technique of MISS, but only 27% had thorough descriptions that included visual representations while 26% failed to describe the procedure. Only 12 results were HONcode certified, and 10 (83%) of these were authored by a medical industry company. CONCLUSIONS Internet-based resources on MISS provide inconsistent content and tend to emphasize benefits of MISS over risks.
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Kondo M, Oshima Y, Inoue H, Takano Y, Inanami H, Koga H. Significance and pitfalls of percutaneous endoscopic lumbar discectomy for large central lumbar disc herniation. JOURNAL OF SPINE SURGERY 2018; 4:79-85. [PMID: 29732426 DOI: 10.21037/jss.2018.03.06] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background Percutaneous endoscopic lumbar discectomy (PELD) is a relatively less invasive treatment for lumbar disc herniation (LDH). The present study focused on the transforaminal approach (TFA) and investigated the significance of PELD via this approach for large central LDH. Methods LDH that did not show cerebrospinal fluid (CSF) on axial T2-weighted magnetic resonance images was defined as large central LDH. PELD via the TFA was performed in 11 patients with large central LDH. Pre- and post-operative statuses were evaluated using the modified Japanese Orthopedic Association (mJOA) and Numerical Rating Scale (NRS) scores. Results The patients' mean age was 44.1 years; there was single-level involvement, mostly at L4/5 (seven cases). The mean recovery rate of the mJOA score was 48.7%, and mean pre- and post-operative NRS scores were 7.1 and 1.5, respectively. The mean operative time was 38.1 min. Although there were no major complications, the dura was accidentally punctured at the initial operative step for discography in one case. LDH recurred in one case at 5 months after the operation, and the patient was treated by PELD via the TFA on the contralateral side. Conclusions The TFA for PELD is a safe, minimally invasive, effective treatment for large central LDH. However, the operator should pay attention to malpositioning of the flat and laterally expanded dural sac.
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Affiliation(s)
- Mikihito Kondo
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hirokazu Inoue
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan
| | - Yuichi Takano
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
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The Early Clinical Outcomes of a Percutaneous Full-Endoscopic Interlaminar Approach via a Surrounding Nerve Root Discectomy Operative Route for the Treatment of Ventral-Type Lumbar Disc Herniation. BIOMED RESEARCH INTERNATIONAL 2018; 2018:9157089. [PMID: 29619380 PMCID: PMC5829311 DOI: 10.1155/2018/9157089] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Revised: 12/26/2017] [Accepted: 01/16/2018] [Indexed: 01/11/2023]
Abstract
The objective of this study is to introduce a method using a percutaneous full-endoscopic interlaminar approach via a surrounding nerve root discectomy (SNRD) operative route that involves removing the protrusive disc via both the shoulder and the axilla of the corresponding nerve root for the treatment of ventral-type lumbar disc herniation (VLDH) and its early clinical symptoms. Twenty-two patients with VLDH satisfied the inclusion criteria and underwent the full-endoscopic interlaminar approach operation via a SNRD successfully during the period from November 2014 to June 2016. All operations were completed without conversion to other surgical techniques. The average operation time was 78.64 ± 25.97 min (50–145 min). The average removed disc tissue volume was 2.87 ± 0.48 ml (2–3.6 ml). No nerve root injury, infection, or other complications occurred. The postoperative ODI and VAS values of low back and sciatic pain were significantly decreased at each time point compared to preoperative measurements (P < 0.05). The MacNab scores at the 12-month follow-up included 15 excellent and 7 good scores. In summary, a percutaneous full-endoscopic interlaminar approach through SNRD is a safe and effective treatment option for patients with VLDH.
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Yörükoğlu AG, Göker B, Tahta A, Akçakaya MO, Aydoseli A, Sabancı PA, Aras Y, Alkır G, Sencer A, Imer M, Izgi N, Canbolat AT. Fully endoscopic interlaminar and transforaminal lumbar discectomy: Analysis of 47 complications encountered in a series of 835 patients. Neurocirugia (Astur) 2017; 28:235-241. [PMID: 28532963 DOI: 10.1016/j.neucir.2017.03.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2017] [Revised: 03/05/2017] [Accepted: 03/24/2017] [Indexed: 12/12/2022]
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Zeng Y, Bao J, Su J, Tan P, Xie W, Huang Z, Xia H. Novel targeted puncture technique for percutaneous transforaminal endoscopic lumbar discectomy reduces X-ray exposure. Exp Ther Med 2017; 14:2960-2968. [PMID: 28966678 PMCID: PMC5615206 DOI: 10.3892/etm.2017.4917] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 02/01/2017] [Indexed: 12/02/2022] Open
Abstract
The present study explored a method to reduce X-ray exposure dose and avoid targeted puncture complications in percutaneous transforaminal endoscopic lumbar discectomy (PTELD). A total of 66 patients with lumbar disc herniation were divided into two groups for a controlled study. In the experimental group, 31 patients were subjected to PTELD using a novel targeted puncture technique with application of a lumbar disc herniation target collimator. The remaining 35 patients in the control group were subjected to free-hand targeted puncture PTELD. The number of X-ray fluoroscopies performed intraoperatively, targeted puncture accuracy, visual analogue scale for surgical pain and Oswestry disability index of the two groups were statistically analyzed. The experimental and control groups exhibited a statistically significant difference in the number of X-ray fluoroscopies required during the procedure (P<0.01). The number of successful first targeted punctures was 27 (87.1%) in the experimental group and three (8.6%) in the control group, indicating that the puncture accuracy was higher in the experimental group than in the control group. As for the pain response to outer sleeve insertion (local anesthetic injection through the guide sleeve), the experimental group had 25 mild cases (80.6%), five moderate cases (16.1%) and one severe care (3.2%), whereas the control group had five mild cases (14.3%), 19 moderate cases (54.3%) and 11 severe cases (31.4%). These results demonstrated that the overall pain response of the experimental group was milder than that of control group. Due to a larger puncture deviation, the nerve root was touched by the puncture needle in 12 cases in the control group and resulted in one case of severe postoperative infection. In conclusion, the novel targeted puncture technique guided by a lumbar disc herniation target collimator outlined in the present study is able to markedly reduce X-ray exposure dose in PTELD and limit the surgical risk and pain experienced by patients. Mastering this novel puncture technique may aid those new to performing PTELD.
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Affiliation(s)
- Yuedong Zeng
- Department of Spinal Surgery, General Hospital of Guangzhou Military Command of PLA, Affiliated with Southern Medical University, Guangzhou, Guangdong 510000, P.R. China.,Department of Spinal Surgery, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong 518116, P.R. China
| | - Jie Bao
- Department of Spinal Surgery, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong 518116, P.R. China
| | - Jiancheng Su
- Department of Spinal Surgery, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong 518116, P.R. China
| | - Pingxian Tan
- Department of Spinal Surgery, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong 518116, P.R. China
| | - Wei Xie
- Department of Spinal Surgery, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong 518116, P.R. China
| | - Zheng Huang
- Department of Clinical Laboratory, Longgang District Central Hospital of Shenzhen, Shenzhen, Guangdong 518116, P.R. China
| | - Hong Xia
- Department of Spinal Surgery, General Hospital of Guangzhou Military Command of PLA, Affiliated with Southern Medical University, Guangzhou, Guangdong 510000, P.R. China
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Fan G, Wang C, Gu X, Zhang H, He S. Trajectory Planning and Guided Punctures with Isocentric Navigation in Posterolateral Endoscopic Lumbar Discectomy. World Neurosurg 2017; 103:899-905.e4. [PMID: 28427987 DOI: 10.1016/j.wneu.2017.04.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 04/04/2017] [Accepted: 04/06/2017] [Indexed: 10/19/2022]
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Ying GY, Yao Y, Shen F, Wu ZY, Chen CM, Zhu YJ. Percutaneous Endoscopic Removal of Cervical Foraminal Schwannoma via Interlaminar Approach: A Case Report. Oper Neurosurg (Hagerstown) 2017; 14:1-5. [DOI: 10.1093/ons/opx088] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 03/26/2017] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND AND IMPORTANCE
Cervical foraminal schwannomas commonly originate from spinal nerves that pass through the intervertebral foramen of the cervical vertebrae. Because of the proximity of this type of tumor to the vertebral artery and spinal nerves, surgical management remains a major challenge. Conventional open spine surgery usually requires the removal of the articular process and is supplemented by a simultaneous posterolateral spine fusion surgery. To decrease the associated risks of surgical complications by further reducing invasiveness, percutaneous spinal endoscopy may be used for resection of foraminal spinal neoplasm.
CLINICAL PRESENTATION
A 52-yr-old female who presented with neck pains with duration of 1 yr was admitted to our hospital. Physical examination revealed moderate rigidity in the neck and grade 5 muscle strength in both upper and lower limbs. Preoperative magnetic resonance imaging (MRI) scans demonstrated a left-sided lesion at the C3-C4 intervertebral foraminal area. Under C-arm fluoroscopy navigation and neuromonitoring, the endoscope was properly positioned on the same side of the tumor, and a small part of the left C3 inferior and C4 superior lamina were first removed by an endoscopic drill to enlarge the interlaminar space. Next, through an endoscopic working canal, the left intervertebral ligamentum flavum was removed to fully expose the tumor. The tumor mass was finally resected in a piecemeal approach. Postoperative MRI confirmed complete tumor resection.
CONCLUSION
This is the first case report of a total removal of a cervical foraminal schwannoma with a percutaneous spinal endoscopic procedure.
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Affiliation(s)
- Guang-Yu Ying
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Chi-na
| | - Ying Yao
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Chi-na
| | - Fang Shen
- Department of Neurosurgery, Ning-bo No. 2 Hospital, Ningbo, China
| | - Zong-Yang Wu
- Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Tai-wan
| | - Chien-Min Chen
- Department of Neurosurgery, Changhua Christian Hospital, Changhua City, Tai-wan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Yong-Jian Zhu
- Department of Neurosurgery, Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Chi-na
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Kang Q, Li X, Cheng Z, Liu C. Effects of release and decompression techniques on nerve roots through percutaneous transforaminal endoscopic discectomy on patients with central lumbar disc herniation. Exp Ther Med 2017; 13:2927-2933. [PMID: 28587362 PMCID: PMC5450561 DOI: 10.3892/etm.2017.4293] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Accepted: 02/22/2017] [Indexed: 02/07/2023] Open
Abstract
The clinical effects and safety of release and decompression techniques on nerve roots through percutaneous transforaminal endoscopic discectomy (PTED) while treating patients with central lumbar disc herniation (CLDH) were explored. Patient cases of lumbar and leg pain treated in Bethune International Peace Hospital from July 2013 to October 2015 were collected retrospectively. The patients in these cases received imaging examinations such as computed tomography and magnetic resonance imaging. Among these cases, 37 CLDH patients with no other complications were selected for this study. A total of 22 males and 15 females aged 28–54 years, with an average age of 36.8±1.5 years, were the subjects of the study. Their disease course was from 1 month to 3 years, with a median course time of 1.5 years. Visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) scoring and the MacNab method were used to evaluate treatment effects. After permission from patients or their family members, release and decompression techniques of nerve roots were performed through PTED. All patients had successful surgery. Their average surgery time was 41.3 (25.5–57.1) min. A physician followed-up each patient from 0 to 18 months after surgery, with the average follow-up period of 12.1 months. VAS scoring of lower limbs was 7.95±0.82 before surgery and 2.28±0.35, 3 months after surgery. VAS scoring of lower limbs was 2.06±0.58, 1 year after surgery and 2.12±0.23 at the last follow-up appointment. JOA scoring was 12.6±0.72 before surgery and 20.4±1.08, 3 months after surgery. JOA scoring was 21.1±0.82 1 year after surgery and 21.2±0.36 at the last follow-up. Differences are of statistical significance (P<0.05). There were no complications for any of the cases. One patient did not improve after surgery, so a laminectomy and bone grafting internal fixation were performed. Two patients relapsed after surgery and received laminectomy and bone grafting internal fixation. The total percentage of excellent and good rates was 83.5%. In conclusion, release and decompression techniques on nerve roots using PTED while treating CLDH resulted in a safe, effective and less traumatic outcome with fewer complications and quicker pain relief than alternative treatments. Due to the results of this study, the use of these techniques in treating CLDH should be more widely considered.
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Affiliation(s)
- Qiangjun Kang
- Department of Orthopedics, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, P.R. China
| | - Ximing Li
- Department of Orthopedics, The First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, P.R. China
| | - Zishen Cheng
- Department of Orthopedics, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, P.R. China
| | - Chang'An Liu
- Department of Orthopedics, Bethune International Peace Hospital, Shijiazhuang, Hebei 050082, P.R. China
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Tonosu J, Oshima Y, Shiboi R, Hayashi A, Takano Y, Inanami H, Koga H. Consideration of proper operative route for interlaminar approach for percutaneous endoscopic lumbar discectomy. JOURNAL OF SPINE SURGERY 2016; 2:281-288. [PMID: 28097245 DOI: 10.21037/jss.2016.11.05] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) is one of the less invasive treatments of lumbar disc herniation (LDH), and has three different operative approaches. This study focused on the interlaminar approach (ILA) and investigated the appropriate operative route for this approach. METHODS ILA was performed in 41 patients with LDH. The width of the interlaminar space, LDH size, and positional relation between LDH and the corresponding nerve root were radiologically evaluated. Thirty-three LDHs were removed via the shoulder of the corresponding nerve root and eight were removed via the axilla of the corresponding nerve root and dural sac. Pre- and postoperative status were evaluated using the modified Japanese Orthopedic Association (mJOA) and numerical rating scale (NRS) scores. RESULTS The mean age was 41.5 years; there was single-level involvement, mostly at L5/S1 (33 cases). The mean recovery rate of mJOA score was 59.8% and mean pre- and postoperative NRS scores were 5.8 and 0.98, respectively. Relatively severe complications developed in three patients treated by ILA via the shoulder. There was persistent numbness in the corresponding nerve area, transient muscular weakness, and transient bladder and rectal disturbance, may be due to excessive compression of the nerve root and/or dural sac by the endoscopic sheath. CONCLUSIONS ILA can be used to treat LDH revealing an interlaminar space of ≥20 mm. The procedure is minimally invasive and effective; however, appropriate selection of an operative route is important to avoid operative complications. Particularly for large LDH, the operative route via the axilla should be considered.
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Affiliation(s)
- Juichi Tonosu
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan;; Department of Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa, Japan
| | - Yasushi Oshima
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ryutaro Shiboi
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Akihiko Hayashi
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Yuichi Takano
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan;; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
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Gadjradj PS, van Tulder MW, Dirven CMF, Peul WC, Harhangi BS. Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series. Neurosurg Focus 2016; 40:E3. [PMID: 26828884 DOI: 10.3171/2015.10.focus15484] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed. The primary outcomes were the visual analog scale (VAS) score for leg pain and the score on the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes were the perceived experience with the local anesthesia used and satisfaction with the results after 1 year using Likert-type scales. The pretreatment means were compared with the means obtained 6 and 52 weeks after surgery using paired t-tests. RESULTS A total of 166 patients underwent surgery for a total of 167 LDHs. The mean duration of surgery (± SD) was 51.0 ± 9.0 minutes. The 1-year follow-up rate was 95.2%. The mean reported scores on the VAS and QBPDS were 82.5 ± 17.3 mm and 60.0 ± 18.4 at baseline, respectively. Six weeks after surgery, the scores on the VAS and QBPDS were significantly reduced to 28.8 ± 24.5 mm and 26.7 ± 20.6, respectively (p < 0.001). After 52 weeks of follow-up, the scores were further reduced compared with baseline scores (p < 0.001) to 19.6 ± 23.5 mm on the VAS and 20.2 ± 18.1 on the QBPDS. A total of 4 complications were observed, namely 1 dural tear, 1 deficit of ankle dorsiflexion, and 2 cases of transient paresis in the foot due to the use of local anesthetics. CONCLUSIONS PTED appears to be a safe and effective intervention for LDH and has similar clinical outcomes compared to conventional open microdiscectomy. High-quality randomized controlled trials are required to study the efficacy and cost-effectiveness of PTED.
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Affiliation(s)
- Pravesh S Gadjradj
- Department of Neurosurgery, Erasmus Medical Center;,Department of Neurosurgery, Leiden University Medical Center, Leiden;,Faculty of Earth and Life Sciences, Department of Health Sciences, VU University Amsterdam, The Netherlands
| | - Maurits W van Tulder
- Faculty of Earth and Life Sciences, Department of Health Sciences, VU University Amsterdam, The Netherlands
| | | | - Wilco C Peul
- Department of Neurosurgery, Leiden University Medical Center, Leiden
| | - B Sanjay Harhangi
- Department of Neurosurgery, Erasmus Medical Center;,Department of Neurosurgery, Park Medical Center, Rotterdam
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Yörükoğlu AG, Tahta A, Akçakaya MO, Sabancı PA, Aras Y, Aydoseli A, Dolgun M, Sencer A, Hepgül K. Percutaneous Fully Endoscopic İnterlaminar Approach to the Filum Terminale: A Cadaveric Study. World Neurosurg 2016; 92:402-406. [PMID: 27241095 DOI: 10.1016/j.wneu.2016.05.055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 05/18/2016] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To investigate the utility, safety, and feasibility of a novel endoscopic technique for the visualization and surgical manipulation of the filum terminale in fresh postmortem adult human cadavers. METHODS The filums from 18 fresh postmortem adult human cadavers were explored with a percutaneous fully endoscopic interlaminar approach. After the filum was identified and the nerve roots were dissected away from it, the filum was cut. A specimen was sent for histopathologic examination. RESULTS In 15 of 18 (83%) cadavers, the filum terminale could be visualized. A specimen for histopathologic examination was obtained from 11 of 15 (73%) visualized filums. Histopathologic examination revealed that 2 of them were fatty filums, 7 were normal filums, and 2 were peripheral nerves. CONCLUSIONS We have described a successful and feasible percutaneous fully endoscopic interlaminar approach to the filum terminale. This technique provides a smaller skin incision, narrow durotomy, and minimal tissue damage. Animal studies are necessary to prove the feasibility and safety of our method before clinical use.
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Affiliation(s)
| | - Alican Tahta
- Department of Neurosurgery, Iğdır State Hospital, Iğdır, Turkey
| | | | - Pulat Akın Sabancı
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Yavuz Aras
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Aydın Aydoseli
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Müge Dolgun
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Altay Sencer
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
| | - Kemal Hepgül
- Department of Neurosurgery, Istanbul School of Medicine, Istanbul University, Istanbul, Turkey
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Machado GC, Witzleb AJ, Fritsch C, Maher CG, Ferreira PH, Ferreira ML. Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta-analysis of cohort studies. Eur J Pain 2016; 20:1700-1709. [PMID: 27172245 DOI: 10.1002/ejp.893] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVE The clinical course of patients with sciatica is believed to be favourable, but there is conflicting evidence on the postoperative course of this condition. We aimed to investigate the clinical course of sciatica following surgery. DATABASES AND DATA TREATMENT An electronic search was conducted on MEDLINE, EMBASE and CINAHL from inception to April 2015. We screened for prospective cohort studies investigating pain or disability outcomes for patients with sciatica treated surgically. Fractional polynomial regression analysis was used to generate pooled means and 95% confidence intervals (CI) of pain and disability up to 5 years after surgery. Estimates of pain and disability (converted to a 0-100 scale) were plotted over time, from inception to last available follow-up time. RESULTS Forty records (39 cohort studies) were included with a total of 13,883 patients with sciatica. Before surgery, the pooled mean leg pain score was 75.2 (95% CI 68.1-82.4) which reduced to 15.3 (95% CI 8.5-22.1) at 3 months. Patients were never fully recovered in the long-term and pain increased to 21.0 (95% CI 12.5-29.5) at 5 years. The pooled mean disability score before surgery was 55.1 (95% CI 52.3-58.0) and this decreased to 15.5 (95% CI 13.3-17.6) at 3 months, and further reduced to 13.1 (95% CI 10.6-15.5) at 5 years. CONCLUSIONS Although surgery is followed by a rapid decrease in pain and disability by 3 months, patients still experience mild to moderate pain and disability 5 years after surgery. WHAT DOES THIS REVIEW ADD?: This review provides a quantitative summary of the postoperative course of patients with sciatica. Patients with sciatica experienced a rapid reduction in pain and disability in the first 3 months, but still had mild to moderate symptoms 5 years after surgery. Although no significant differences were found, microdiscectomy showed larger improvements compared to other surgical techniques.
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Affiliation(s)
- G C Machado
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia.
| | - A J Witzleb
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - C Fritsch
- Department of Physiotherapy, Universidade Federal de Ciências da Saúde de Porto Alegre, Brazil
| | - C G Maher
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia
| | - P H Ferreira
- Faculty of Health Sciences, The University of Sydney, NSW, Australia
| | - M L Ferreira
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, NSW, Australia.,Institute of Bone and Joint Research, The Kolling Institute, Sydney Medical School, The University of Sydney, NSW, Australia
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Serum creatine phosphokinase levels as an indicator of muscle injury following lumbar disc surgery: Comparison of fully endoscopic discectomy and microdiscectomy. Clin Neurol Neurosurg 2016; 145:74-8. [PMID: 27101087 DOI: 10.1016/j.clineuro.2016.04.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Revised: 04/02/2016] [Accepted: 04/05/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study is to make a comparison between fully endoscopic lumbar discectomy (FELD) and conventional microdiscectomy (MD) by using pre- and postoperative serum creatine phosphokinase (CPK) levels in correlation with postoperative low-back pain. METHODS Fortyfive consecutive patients who underwent surgery for lumbar disc herniation were allocated into three groups with 15 patients on each: (1) FELD with interlaminar approach (IL), (2) FELD with transforaminal approach (TF), (3) Conventional MD. Serum CPK levels pre- and 1, 6, 12 and 24h postoperatively, patients' body mass index (BMI), operation duration and hospital stays were recorded. The low-back pain pre- and postoperatively was assessed with the use of the 100mm visual analog scale (VAS) and the "Oswestry Disability Index" (ODI). RESULTS There were 16 female (35.5%) and 29 male (64.5%) patients with a mean age of 44.1 years. CPK levels at 6th, 12th and 24th hours postoperatively were found significantly lower in TF and IL groups compared to MD group (p<0.004). Mean operation duration was significantly shorter in MD group (p: 0.014). There was a significant decrease in both the VAS and ODI scores after the surgery in all patient groups (p<0.001). Postoperative VAS scores were found significantly higher in MD group (p: 0.04). CONCLUSION Minimal invasive nature of FELD procedures compared to the MD was substantiated by serum CPK levels in this study. To draw definitive conclusions regarding pain relief, larger patient samples should be evaluated, although postoperative VAS scores were found in favor of FELD.
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Ahn SS, Kim SH, Kim DW. Learning Curve of Percutaneous Endoscopic Lumbar Discectomy Based on the Period (Early vs. Late) and Technique (in-and-out vs. in-and-out-and-in): A Retrospective Comparative Study. J Korean Neurosurg Soc 2015; 58:539-46. [PMID: 26819689 PMCID: PMC4728092 DOI: 10.3340/jkns.2015.58.6.539] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Revised: 07/08/2015] [Accepted: 10/28/2015] [Indexed: 12/16/2022] Open
Abstract
Objective To report the learning curve of percutaneous endoscopic lumbar discectomy (PELD) for a surgeon who had not been previously exposed to this procedure based on the period and detailed technique with a retrospective matched comparative design. Methods Of 213 patients with lumbar disc herniation encountered during the reference period, 35 patients who were followed up for 1 year after PELD were enrolled in this study. The patients were categorized by the period and technique of operation : group A, the first 15 cases, who underwent by the 'in-and-out' technique; group B, the next 20 cases, who underwent by the 'in-and-out-and-in' technique. The operation time, failure rate, blood loss, complication rate, re-herniation rate, the Visual Analogue Scale (VAS) for back and leg were checked. The alteration of dural sac cross-sectional area (DSCSA) between the preoperative and the postoperative MRI was checked. Results Operative time was rapidly reduced in the early phase, and then tapered to a steady state for the 35 cases receiving the PELD. After surgery, VAS scores for the back and leg were decreased significantly in both groups. Complications occurred in 2 patients in group A and 2 patients in group B. Between the two groups, there were significant differences in operative time, improvement of leg VAS, and expansion of DSCSA. Conclusion PELD learning curve seems to be acceptable with sufficient preparation. However, because of their high tendency to delayed operation time, operation failure, and re-herniation, caution should be exercised at the early phase of the procedure.
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Affiliation(s)
- Sang-Soak Ahn
- Department of Neurosurgery, Spine and Spinal Cord Institute, Gangnam Severance Spine Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sang-Hyeon Kim
- Department of Radiology, Dong-A University Medical Center, Busan, Korea
| | - Dong-Won Kim
- Department of Radiology, Dong-A University Medical Center, Busan, Korea
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Outcomes of Microendoscopic Discectomy and Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation: A Comparative Retrospective Study. Asian Spine J 2015; 9:833-40. [PMID: 26713113 PMCID: PMC4686386 DOI: 10.4184/asj.2015.9.6.833] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 11/16/2022] Open
Abstract
Study Design Retrospective, case control evaluation of 86 patients who underwent microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED) for the treatment of lumbar disc herniation (LDH). Purpose To evaluate the safety and the outcomes of MED and PTED for the treatment of LDH. Overview of Literature MED and PTED are minimally invasive surgical techniques for lower back pain. Studies to date have shown that MED and PTED are safe and effective treatment modalities for LDH. Methods A retrospective study was performed in patients with LDH treated with MED (n=50) and transforaminal endoscopic discectomy (PTED; n=36) in our hospital. All patients were followed-up with self-evaluation questionnaires, Oswestry disability index (ODI), medical outcomes study 36-item short form health survey and MacNab criteria. All the patients in both groups were followed up to 12 months after the operation. Results ODI questionnaire responses were not statistically different between the MED and PTED groups (53.00 vs. 48.72) before treatment. Average scores and minimal disability after 5 days to 12 months of follow-up were 4.96 in the MED group and 3.61 in the PTED group. According to MacNab criteria, 92.0% of the MED group and 94.4% of the PTED group had excellent or good results with no significant difference. Conclusions There was no significant difference between MED and PTED outcomes. Further large-scale, randomized studies with long-term follow-up are needed.
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