Is Microendoscopic Discectomy Effective for Patients With Concomitant Lumbar Disc Herniation and Spondylolysis?

Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation

STUDY DESIGN

Retrospective Comparative Study.

OBJECTIVES

To compare the outcomes of microendoscopic discectomy (MED) versus full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH).

METHODS

A retrospective study was performed on patients with L4/5 LDH treated using MED (n = 249) or FED (n = 124). A 16-mm tubular retractor and endoscope was used for MED, while a 4.1-mm working channel endoscope was used for FED. Patient background and operative data were collected. The Oswestry Disability Index (ODI) and European Quality of Life-5 Dimensions (EQ-5D) scores were recorded preoperatively and at 1 and 2 years postsurgery.

RESULTS

The background data of the two groups were similar. The mean operation times for MED and FED were 59.3 and 47.7 min (respectively), and the mean volumes of removed nucleus pulposus were .65 and 1.03 g, respectively. These differences were significant (P < .001). Six dural tears and one postoperative hematoma were observed in the MED group; none were observed in the FED group. During the follow-up period, 16 MED and 7 FED patients required re-operation due to recurrence (P = 1.00). Although the ODI and EQ-5D scores significantly improved at 1 and 2 years postsurgery in both groups, the differences were not statistically significant.

CONCLUSIONS

Operative outcomes were almost identical in both groups. We did not observe any operative or postoperative complications in FED. We, therefore, recommend FED as the first option for the treatment of L4/5 LDH since it has a better safety profile and is minimally invasive.

Large-Scale Comparative Study Between Microendoscopic Laminectomy and Full-Endoscopic Laminectomy for the Treatment of Single-Level Lumbar Spinal Canal Stenosis

BACKGROUND

We previously compared the operative outcomes of microendoscopic laminectomy (MEL) and full-endoscopic laminectomy (FEL) for single-level lumbar spinal canal stenosis (LSCS). In this initial report, the operative outcomes of FEL were not inferior to those of MEL.

OBJECTIVE

The purpose of this study is to compare the outcomes of MEL and FEL for single-level LSCS on a large scale using widely used multiple evaluation methods.

METHODS

MEL was performed using a 16 mm tubular retractor and an endoscope, while FEL was performed using a 6.4 mm working channel endoscope. A retrospective study was performed on patients with LSCS treated with MEL (n = 355) or FEL (n = 154). Patient background and operative data were also collected. The Oswestry Disability Index (ODI), European Quality of Life-5 Dimensions (EQ-5D), and 36-item Short Form Survey (SF-36) scores were recorded preoperatively and 1-year postoperatively.

RESULTS

Background data of the two groups and the mean operation time (MEL, 72.1 m; FEL, 74.2 m) were not significant (p>0.2). The mean volumes of intraoperative bleeding (MEL, 25.2 ml; FEL, 10.3 ml) were significantly different (p<0.001). The mean postoperative hospital stays (MEL, 3.9 days; FEL, 2.1 days) were significantly different (p<0.001). Fifteen dural tears (MEL, 11; FEL, 4) and 1 surgical site infection (MEL, 1; FEL, 0) were observed but not significant (p>0.5). Reoperation was required for postoperative hematoma in five patients (MEL, 3; FEL, 2). Although the ODI, EQ-5D, and SF-36 scores improved significantly at one year postoperatively in the MEL and FEL groups (p<0.001), there were no significant differences between the two groups (p>0.1).

CONCLUSION

The operative outcomes and minimal invasiveness were no statistical difference between the MEL and FEL groups. Further development of the operative techniques and the instruments of FEL are required to shorten the operation time.

Clinical comparison of unilateral biportal endoscopic discectomy with percutaneous endoscopic lumbar discectomy for single l4/5-level lumbar disk herniation

OBJECTIVE

The purpose of this research was to investigate the outcomes between unilateral biportal endoscopic discectomy (UBE) and percutaneous endoscopic lumbar discectomy (PELD) for the single L4/5-level lumbar disk herniation (sLDH).

METHODS

From January 2018 to January 2021, a total of 40 patients with sLDH were retrospectively analyzed in this study. All the patients had received spinal surgeries in Affiliated Hospital of Nantong University and Affiliated Nantong Hospital 3 of Nantong University. Among them, 20 patients were treated with PELD (PELD group), and 20 patients were treated with UBE discectomy (UBE group). Postoperative length of hospital stay, estimated blood loss, operation time, and clinical complications of the patients were compared between the two groups. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were measured before surgeries and 3 days, 1, and 6 months after surgeries.

RESULTS

Compared with the UBE group, the PELD group had obviously less intraoperative blood loss, shorter operative time, and shorter hospital stay. The differences in the rate of complications were not statistically significant between the two groups. The VAS score and the ODI score of the two groups had a great reduction after operation. In addition, both the groups had satisfactory clinical outcome; the VAS score and ODI of the PELD group decreased more obviously.

CONCLUSION

The UBE for sLDH yielded similar clinical outcomes to PELD as minimally invasive surgeries; however, PELD is superior to UBE in terms of intraoperative blood loss, operative time, postoperative hospitalization, and short-term postoperative pain relief. The advantages and disadvantages of the two surgeries should be circumspectly balanced when evaluating a patient for a minimally invasive surgery for sLDH, selecting the most appropriate surgical method for patients.

One-year clinical outcome after full-endoscopic interlaminar lumbar discectomy for isthmic lumbar spondylolisthesis: Two case reports

RATIONALE

For isthmic lumbar spondylolisthesis (ILS) associated with the removal of herniation, it remains challenging to perform less invasive and minimally disruptive procedures. Good results could potentially be obtained by further preserving the posterior elements in full-endoscopic lumbar discectomy (FESS), which is less invasive than microenscopic surgery (MES).

PATIENT CONCERNS

One patient complained of left leg pain, and another patient complained of right leg pain and low back pain.

DIAGNOSES

Two patients with ILS and Meyerding Grade 1 lumbar spondylolisthesis.

INTERVENTIONS

We performed a full-endoscopic lumbar discectomy via the interlaminar space (FESS-IL) for L5/S1 lumbar disc herniation (LDH) accompanied by isthmic lumbar spondylolisthesis. FESS-IL was performed in 2 patients with radiculopathy caused by different types of LDH using a full endoscopic system with a 4.1 mm working channel and 6.9 mm outer diameter. A 3.5-mm diameter high-speed drill was used in one patient for an upward-migrated LDH in the inner-rim of the infravertebral border. The other patient underwent minimal resection without bone resection.

OUTCOMES

The one-year clinical outcome included confirmation of pain relief and evacuation of migrated LDH on magnetic resonance imaging in all patients. There was no progression of slippage on radiography. The mean operative time was 82 min, and no complication was observed. The one-year clinical outcome demonstrated sufficient pain relief.

LESSONS THE Y

ear postoperative outcome showed improvement. We believe that FESS-IL is a viable alternative operative approach for LDH for ILS.

Comparative Study between Full-Endoscopic Discectomy and Microendoscopic Discectomy for the Treatment of Lumbar Disc Herniation

Background and objectives: Lumbar disc herniation (LDH) is a common disease in the meridian of life. Although surgical discectomy is commonly used to treat LDH, there are several different strategies. We compared the outcomes of uniportal full-endoscopic discectomy (FED) with those of microendoscopic discectomy (MED) in treating LDH. Materials and Methods: FED was performed using a 4.1-mm working channel endoscope, and MED was performed using a 16-mm diameter tubular retractor and endoscope. Data of patients with LDH treated with FED (n = 39) or MED (n = 27) by the single surgeon were retrospectively reviewed. Patient background information and operative data were collected. Pre- and postoperative low back and leg pain were evaluated using the numerical rating scale (NRS) score. Pre- and postoperative disc height index (DHI) values were calculated from plain radiographs, and the disc height loss was evaluated using the ratio (DHI ratio); Results: The median (interquartile range (IQR) Q25–75) operation times for FED and MED were 42 (33–61) and 43 (33–50) minutes, respectively. The median (IQR Q25–75) pre- and postoperative NRS scores for low back pain were 5 (2–7) and 1 (0–4), respectively, for FED and 6 (3–8) and 1 (0–2), respectively, for MED. The median (IQR Q25–75) pre- and postoperative NRS scores for leg pain were 7 (5–8) and 0 (0–2), respectively, for FED and 6 (5–8) and 0 (0–2), respectively, for MED. These data were not different between the FED and MED groups. The median (IQR Q25–75) DHI ratios of FED and MED were 0.94 (0.89–1.03) and 0.90 (0.79–0.95), respectively. The DHI ratio was significantly higher (p < 0.05) in the FED group than in the MED group, and there was less blood loss; Conclusions: The pain-relieving effect of FED in treating LDH was almost identical to that of MED. However, FED was superior to MED in preventing disc height loss, which is one of the indicators of postoperative disc degeneration.