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Aiyer R, Noori S, Schirripa F, Schirripa M, Jain S, Aboud T, Mehta N, Elowitz E, Pahuta M, Datta S. A systematic review of full endoscopic versus micro-endoscopic or open discectomy for lumbar disc herniation. Pain Manag 2021; 12:87-104. [PMID: 34420416 DOI: 10.2217/pmt-2021-0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Endoscopic discectomies provide several advantages over other techniques such as traditional open lumbar discectomy (OLD) including possibly decreased complications, shorter hospital stay and an earlier return to work. Methods: An electronic database search including MEDLINE/PubMed, EMBASE, Scopus, Cochrane Database of Systematic Reviews and Cochrane Controlled trials (CENTRAL) were reviewed for randomized controlled trials (RCTs) only. Results: A total of nine RCTs met inclusion criteria. Three showed benefit of endoscopic discectomy over the comparator with regards to pain relief, with the remaining six studies showing no difference in pain relief or function. Conclusion: Based on review of the nine included studies, we can conclude that endoscopic discectomy is as effective as other surgical techniques, and has additional benefits of lower complication rate and superior perioperative parameters.
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Affiliation(s)
- Rohit Aiyer
- Department of Anesthesiology, Pain Management & Perioperative Medicine, Henry Ford Health System, Detroit, MI 48202, USA
| | | | - Frank Schirripa
- Division of Rehabilitation & Regenerative Medicine, New York-Presbyterian Hospital, Cornell & Columbia Campuses, New York, NY 10021, USA
| | - Michael Schirripa
- Department of Anesthesiology, New York-Presbyterian/Brooklyn Methodist Hospital, Brooklyn, NY 11215, USA
| | - Sameer Jain
- Pain Treatment Centers of America, White Hall, AK 71602, USA
| | - Talal Aboud
- Department of Neurology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Neel Mehta
- Division of Pain Medicine, Department of Anesthesiology, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10021, USA
| | - Eric Elowitz
- Department of Neurosurgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY 10021, USA
| | - Markian Pahuta
- Department of Orthopedic Surgery, Henry Ford Health System, Detroit, MI 48202, USA
| | - Sukdeb Datta
- Datta Endoscopic Back Surgery & Pain Center, Professorial Lecturer, Mount Sinai School of Medicine, Department of Anesthesiology, New York, NY 10029, USA
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Wang A, Yu Z. Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for Highly Migrated Lumbar Disc Herniation. J Pain Res 2021; 14:1587-1592. [PMID: 34113166 PMCID: PMC8187084 DOI: 10.2147/jpr.s303930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/19/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To describe minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for highly migrated lumbar disc herniation (LDH) and assess its clinical outcomes. Patients and Methods This research retrospectively assessed 25 patients who were diagnosed with one-segmental highly migrated LDH and underwent MIS-TLIF in Peking University First Hospital from June 2015 to September 2019. Demographic data, perioperative parameters, complications, recurrence, and surgical outcomes were assessed. Results Twelve males and 13 females, with a mean age of 56.68 years old, were involved and the follow-up period was at least one year. The mean operation time was 222.16 minutes, the mean intraoperative hemorrhage was 250.00 mL, and the mean post-operative hospitalization was 5.76 days. The improvements in visual analog scale (VAS) and Oswestry disability index (ODI) were statistically significant. In addition, based on the MacNab criteria, 22 patients (88.0%) acquired satisfactory (good or excellent) results. One patient underwent post-operative epidural hematoma and recovered after evacuation of the hematoma. No recurrence was found. Conclusion MIS-TLIF is safe and effective and it can provide satisfactory clinical outcomes for highly migrated LDH.
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Affiliation(s)
- Anqi Wang
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhengrong Yu
- Department of Orthopedics, Peking University First Hospital, Beijing, People's Republic of China
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Wang A, Yu Z. Comparison of Percutaneous Endoscopic Lumbar Discectomy with Minimally Invasive Transforaminal Lumbar Interbody Fusion as a Revision Surgery for Recurrent Lumbar Disc Herniation after Percutaneous Endoscopic Lumbar Discectomy. Ther Clin Risk Manag 2020; 16:1185-1193. [PMID: 33363376 PMCID: PMC7754645 DOI: 10.2147/tcrm.s283652] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/09/2020] [Indexed: 01/21/2023] Open
Abstract
Objective The purpose of this study was to compare the outcomes between percutaneous endoscopic lumbar discectomy (PELD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for the revision surgery for recurrent lumbar disc herniation (rLDH) after PELD surgery. Patients and Methods A total of 46 patients with rLDH were retrospectively assessed in this study. All the patients had received a PELD in Peking University First Hospital between January 2015 and June 2019, before they underwent a revision surgery by either PELD (n=24) or MIS-TLIF (n=22). The preoperative data, perioperative conditions, complications, recurrence condition, and clinical outcomes of the patients were compared between the two groups. Results Compared to the MIS-TLIF group, the PELD group had significantly shorter operative time, less intraoperative hemorrhage, and shorter postoperative hospitalization, but higher recurrence rate (P<0.05). Complication rates were comparable between the two groups. Both groups had satisfactory clinical outcomes at a 12-month follow-up after the revision surgery. The PELD group also showed significantly lower visual analog scale (VAS) scores of back pain and Oswestry disability index (ODI) in one month after the revision surgery, whereas the difference was not detectable at six- and 12-month follow-ups. Conclusion Both PELD and MIS-TLIF are effective as a revision surgery for rLDH after primary PELD. PELD is superior to MIS-TLIF in terms of operative time amount of intraoperative hemorrhage and postoperative hospitalization. However, its higher postoperative recurrence rate must be considered and patients should be well informed, when making a decision between the two surgical approaches.
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Affiliation(s)
- Anqi Wang
- Department of Orthopedics, Peking University First Hospital, Peking, People's Republic of China
| | - Zhengrong Yu
- Department of Orthopedics, Peking University First Hospital, Peking, People's Republic of China
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Early outcomes of transforaminal percutaneous endoscopic lumbar discectomy for high school athletes with herniated nucleus pulposus of the lumbar spine. J Pediatr Orthop B 2020; 29:599-606. [PMID: 32301825 DOI: 10.1097/bpb.0000000000000726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are no reports in the literature on the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) for high school athletes suffering from herniated nucleus pulposus (HNP) of the lumbar spine. PELD is a minimally invasive surgical procedure that can be performed under local anesthesia via an 8-mm skin incision. This study examined the outcomes of transforaminal PELD in high school athletes suffering from HNP. Subjects were 18 patients [14 males and four females; mean age 17 (15-18) years] who underwent PELD at our institutions. The events in which the patients competed were baseball (n = 6), softball (n = 2), rugby (n = 2), basketball (n = 2), table tennis (n = 2), American football (n = 1), wrestling (n = 1), track and field (n = 1), and dance (n = 1). All patients underwent PELD under local anesthesia. Back pain was assessed using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and a visual analog scale (VAS) before and after surgery. Time to return to competitive sport, complications, and rate of recurrence of herniation were examined. All factors assessed by the JOABPEQ were significantly improved after surgery. VAS score was also improved after surgery. Time to return to competitive sport was 7 weeks on average. The rate of return to play was 94.4%. There were no complications, such as dural tear, exiting nerve root injury, or hematoma. One patient had recurrence of HNP. PELD is a promising minimally invasive and effective procedure for high school athletes with HNP.
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Sang X, Shan H, Hu J, Wu M. The efficacy of bilateral intervertebral foramen block for pain management in percutaneous endoscopic lumbar discectomy: A protocol for randomized controlled trial. Medicine (Baltimore) 2020; 99:e22693. [PMID: 33031340 PMCID: PMC7544323 DOI: 10.1097/md.0000000000022693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Compared with open lumbar microdiscectomy, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of remarkable preservation of paravertebral structures, less bleeding, shorter operation time and fewer complications, it is a common method for the treatment of lumbar disc herniation (LDH). Local anesthesia is recommended during PELD. However, intraoperative pain is sometimes difficult to control satisfactorily. The efficacy of bilateral intervertebral foramen block (IFB) for pain management in PELD remains unclear. Therefore, this regimen is utilized in a randomized controlled trial for the assessment the safety and effectiveness of bilateral IFB for PELD pain control. METHOD This is a single center and randomized controlled trial which will be implemented from September 2020 to September 2021. This research protocol is in accordance with the items of the Standard Protocol for Randomized Trials, which was authorized through the Ethics Committee of Huzhou Central Hospital & Affiliated Centre Hospital of Huzhou University (HZCH0465-0864). 100 participants who undergo PELD will be analyzed. Inclusion criteria containsThe exclusion criteria contains:Patients will be randomly divided into bilateral IFB group (with 50 patients) and local infiltration analgesia group (with 50 patients). Primary outcomes are pain score at different time points. The secondary outcomes are the operative time, radiation exposure time, length of hospital stay and postoperative complications. All the analysis is implemented through applying the IBM SPSS Statistics for Windows, version 20 (IBM Corp., Armonk, NY, USA). RESULTS The clinical outcome variables between groups are illustrated in the Table 1. CONCLUSION This investigation can offer a reliable basis for the effectiveness and safety of IFB in treating the PELD pain. TRIAL REGISTRATION This study protocol is registered in Research Registry (researchregistry5985).
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Affiliation(s)
- Xiaolan Sang
- Department of operating room, Huzhou Central Hospital & Affiliated Central Hospital of Huzhou University
| | | | | | - Meng Wu
- Department of Orthopedics and Trauma, Huzhou Central Hospital & Affiliated Centre Hospital of Huzhou Unversity, Zhejiang Province, China
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Aprile BC, Amato MCM, de Oliveira CA. Functional Evolution after Percutaneous Endoscopic Lumbar Discectomy, an Earlier Evaluation of 32 Cases. Rev Bras Ortop 2020; 55:415-418. [PMID: 32904845 PMCID: PMC7458753 DOI: 10.1055/s-0039-3402473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/15/2019] [Indexed: 11/07/2022] Open
Abstract
Objective
To determine time period for hospital discharge and pain and function improvement in patients submitted to percutaneous endoscopic lumbar discectomy (PELD).
Methods
Retrospective evaluation of length of stay and visual analog scale (VAS), Oswestry disability index (ODI), and Roland-Morris questionnaire results in 32 patients undergoing PELD at the preoperative period and at 2 days and 1, 2, 4, 6 and 12 postoperative weeks.
Results
All patients were discharged in less than 6 hours. There was a statistically significant improvement between the results obtained before the procedure and 2 days postsurgery: the mean VAS for axial pain went from 6.63 to 3.31, the VAS for irradiated pain went from 6.66 to 2.75, the Oswestry score went from 44.59 to 33.17%, and the Roland-Morris score went from 14.03 to 10.34. This difference progressively improved up to 12 weeks in all questionnaires. Regarding the Oswestry score, minimum disability values (19.39%) were observed at 6 weeks.
Conclusion
All 32 patients were discharged within 6 hours. Pain and function improved significantly after 48 hours, with further significant and progressive improvement until the 3
rd
month.
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Xie P, Feng F, Chen Z, He L, Yang B, Chen R, Wu W, Liu B, Dong J, Shu T, Zhang L, Chen CM, Rong L. Percutaneous transforaminal full endoscopic decompression for the treatment of lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:546. [PMID: 32799839 PMCID: PMC7429717 DOI: 10.1186/s12891-020-03566-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022] Open
Abstract
Background One advantage of an endoscopic approach to treating lumbar spinal stenosis is preservation of spine stability and the adjacent anatomy, and there is a decrease in adjacent segment disc degeneration. The purpose of this study was to discuss the clinical efficacy of percutaneous transforaminal endoscopic decompression for the treatment of lumbar spinal stenosis (LSS). Methods This is a retrospective study. From September 2012 to June 2017, 45 patients who were diagnosed with LSS underwent the treatment of percutaneous transforaminal endoscopic decompression (PTED) and were followed up at 1 week, 3 months and 1 year postoperatively. Low back pain and leg pain were measured by Visual Analogue Scale scoring methods (VAS-back and VAS-leg), while functional outcomes were assessed by using the Oswestry Disability Index (ODI). All patients had one-level lumbar spinal stenosis. Results The most common type of stenosis was lateral recess stenosis (n = 22; 48.9%), followed by central stenosis (n = 13; 28.9%) and foraminal stenosis (n = 10: 22.2%). Regarding comparisons of VAS-back, VAS-leg, and ODI scores before and after operation, VAS and ODI scores significantly improved. The average leg VAS score improved from 7.01 ± 0.84 to 2.28 ± 1.43 (P < 0.001). The average ODI improved from 46.18 ± 10.11 to 14.40 ± 9.59 (P < 0.001). We also examined changes in ODI and VAS scores from baseline according to types of spinal stenosis, stenosis grade, spinal instability, and revision surgery in the same segment. The improvement percentage of leg VAS score was significantly less in patients with severe stenosis at both 3 months and 1 year postoperatively. The improvement percentages of ODI and leg VAS scores were significantly less in patients who had spinal instability and patients who had undergone revision surgery. Conclusion The PTED approach seems to give good results for the treatment of LSS. However, this approach may be less effective for LSS patients who have lumbar instability or require revision surgery in the same segment.
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Affiliation(s)
- Peigen Xie
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Feng Feng
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Zihao Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Lei He
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bu Yang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Ruiqiang Chen
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Wenbin Wu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Bin Liu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Jianwen Dong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Tao Shu
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Liangming Zhang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China
| | - Chien-Min Chen
- Minimally Invasive Spine Center, Changhua Christian Hospital, No.135, Nansiao St., Changhua city, Changhua county, Taiwan.
| | - Limin Rong
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, NO. 600 TianHe Road, TianHe District, GuangZhou, GuangDong Province, China.
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Li L, Hai Y, Yang J, Xu C, Yuan J, Sun J, Wang Q, Yang X. Correlation between preoperative CT imaging parameters and clinical outcome of lumbar spinal stenosis treated with endoscopic transforaminal decompression. J Int Med Res 2020; 48:300060519894078. [PMID: 32339040 PMCID: PMC7218480 DOI: 10.1177/0300060519894078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective To evaluate clinical effects, and their correlations with preoperative computed tomography imaging parameters, in cases of lumbar spinal stenosis treated by endoscopic transforaminal decompression. Methods This retrospective study included orthopaedic patients who had undergone percutaneous endoscopic lumbar discectomy (PELD) for lumbar spinal stenosis. Clinical symptoms were evaluated by visual analogue scale (VAS), Oswestry Disability Index (ODI) and claudication distance. Overall clinical efficacy was evaluated by Macnab score. Results A total of 87 patients were included. Postoperative wound healing was good without complications. Macnab scores following PELD were ‘excellent’ in 41 cases (47.12%), ‘good’ in 30 cases (34.48%), ‘generally good’ in seven cases (8.04%), and ‘poor’ in nine cases (10.34%). The overall rate of optimal surgery was 81.60%. Postoperative pain (VAS) and ODI scores, and claudication distance, were significantly improved versus preoperative values. The soft tissue invasion ratio of the vertebral canal and invasion ratio of the nerve root canal were correlated with clinical efficacy. Conclusion Positive correlations were observed between clinical efficacy of endoscopic transforaminal decompression and preoperative vertebral canal soft tissue invasion ratio and nerve root canal invasion ratio in patients with lumbar spinal stenosis.
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Affiliation(s)
- Lijun Li
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China.,Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Yong Hai
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Jincai Yang
- Department of Orthopaedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Cheng Xu
- MRI Department, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jie Yuan
- CT Department, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Jiuqiang Sun
- Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Qinghua Wang
- Department of Nephrology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Xiaowen Yang
- Department of Orthopaedics, Shanxi Provincial People's Hospital, Taiyuan, China
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Li L, Chang F, Hai Y, Yang J, Xu C, Yuan J, Sun J, Wang Q, Ding S, Yang X. Clinical effect evaluation and correlation between preoperative imaging parameters and clinical effect of endoscopic Transforaminal decompression for lumbar spinal stenosis. BMC Musculoskelet Disord 2020; 21:68. [PMID: 32013945 PMCID: PMC6998066 DOI: 10.1186/s12891-020-3076-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 01/20/2020] [Indexed: 11/24/2022] Open
Abstract
Background The objective of this study was to evaluate the clinical effect and correlation between preoperative imaging parameters and the clinical effect of endoscopic transforaminal decompression for lumbar spinal stenosis. Methods In this prospective study, 87 patients from Shanxi Province People’s Hospital met the criteria for lumbar spinal stenosis and were recruited from June 2014 to January 2016. These patients underwent endoscopic transforaminal decompression. The clinical symptoms were evaluated by VAS, ODI, and claudication at 3 and 6 months after surgery. The overall clinical efficacy was evaluated using the MacNab score. Yellow ligament thickness and area of the dural sac were examined by MRI. Bony vertebral canal area, real spinal canal area, nerve root canal bony area, nerve root canal real area, distance between the articular joints, and vertebral canal sagittal diameter were examined by CT. The soft tissue invasion ratio of the vertebral canal and the invasion ratio of the nerve root canal were calculated. Correlations between imaging parameters and age, sex, and clinical efficacy were examined. Results The MacNab scores were excellent in 47% of cases, good in 34%, generally good in 8%, and poor in 11%. VAS, ODI, and claudication were significantly improved compared with the preoperative values (P < 0.01). A significant difference was observed between the 71–81 year age group and the other age groups (P < 0.05). There were good correlations between clinical efficacy and vertebral canal sagittal diameter, distance between the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal. Conclusion Treatment of lumbar spinal stenosis by endoscopic transforaminal decompression can achieve good clinical results. This operation is less effective in patients older than 71 years of age. There were positive correlations between clinical efficacy and the vertebral canal sagittal diameter, the articular joints, soft tissue invasion ratio of the vertebral canal, and invasion ratio of the nerve root canal.
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Affiliation(s)
- Lijun Li
- Department of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China.,Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Feng Chang
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Yong Hai
- Department of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China.
| | - Jincai Yang
- Department of Orthopedics, Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing, China
| | - Cheng Xu
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Jie Yuan
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Jiuqiang Sun
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Qinghua Wang
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Shengqiang Ding
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
| | - Xiaowen Yang
- Department of Orthopedics, Shanxi Provincial People's Hospital, Shanxi, China
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Priola SM, Ganau M, Raffa G, Scibilia A, Farrash F, Germanò A. A Pilot Study of Percutaneous Interlaminar Endoscopic Lumbar Sequestrectomy: A Modern Strategy to Tackle Medically-Refractory Radiculopathies and Restore Spinal Function. Neurospine 2019; 16:120-129. [PMID: 30943714 PMCID: PMC6449818 DOI: 10.14245/ns.1836210.105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 12/02/2018] [Indexed: 12/02/2022] Open
Abstract
Objective Angled scopes allow 360° visualization, which makes percutaneous endoscopic techniques (percutaneous endoscopic lumbar discectomy, PELD) particularly attractive for sequestrectomies, which entail the removal of extruded lumbar disc fragments that have migrated caudally or cranially between the ligaments, foramina, and neural structures, while preserving the disc. Although many different PELD techniques are currently available, not all of them are suitable for sequestrectomies; furthermore, long-term follow-up data are unfortunately lacking.
Methods A pilot study was conducted on a cohort of 270 patients with lumbar radiculopathy undergoing minimally invasive spine surgery (PELD or microdiscectomy), of whom only 7 were eligible for endoscopic interlaminar sequestrectomy with disc preservation. The patients’ baseline conditions and clinical outcomes were measured with the Oswestry Disability Index and a visual analogue scale. Long-term follow-up was conducted using satisfaction questionnaires that were based on the MacNab criteria and administered by medical/nursing personnel not involved in their primary surgical management.
Results EasyGo system was eventually used in 5 PELD cases. No dural tears, infections, or nerve root injuries were recorded in patients undergoing sequestrectomy. Surgical events, including blood loss and overall length of hospital stay, did not differ significantly among the 270 patients. In the group treated with endoscopic sequestrectomy, no recurrences or complications were noted during a follow-up of 3 years, and an excellent degree of satisfaction was reported.
Conclusion We provide OCEBM (Oxford Centre for Evidence-Based Medicine) level 3 evidence that interlaminar endoscopic sequestrectomy is a tailored and well-tolerated surgical option; nonetheless, a cost-effectiveness analysis assessing the interval until return to working activities and long-term benefits is warranted.
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Affiliation(s)
- Stefano Maria Priola
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy.,Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Mario Ganau
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Giovanni Raffa
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Antonino Scibilia
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
| | - Faisal Farrash
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Antonino Germanò
- Neurosurgical Clinic, Department of Neurosciences, University of Messina, Messina, Italy
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Radiation Exposure and Operation Time in Percutaneous Endoscopic Lumbar Discectomy Using Fluoroscopy-Based Navigation System. World Neurosurg 2019; 127:e39-e48. [PMID: 30802551 DOI: 10.1016/j.wneu.2019.01.289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 11/23/2022]
Abstract
OBJECTIVE This study evaluated radiation exposure and operation time of percutaneous endoscopic lumbar discectomy (PELD) by using a fluoroscopy-based navigation system for access and localization. METHODS Eighty-six PELDs performed by a single surgeon were retrospectively analyzed. Patients were separated into 2 groups: group A (using a three-dimensional [3D]-printed navigation instrument and fluoroscopy-based navigation system) and group B (with conventional fluoroscopy and standard instrumentation). The operation, fluoroscopy, and total access time were collected, as well as fluoroscopy and access times. RESULTS The operative time for group A was 59 minutes (standard deviation [SD], 6 minutes) and 106 minutes (SD, 15 minutes) in group B (P < 0.001). In group A, fluoroscopy was used an average of 5 times (SD, 0.7) and 29 times (SD, 8) in group B (P < 0.001). The fluoroscopy time was 9 minutes (SD, 2 minutes) in group A and 40 minutes (SD, 8 minutes) in group B (P < 0.001). The number of access attempts was 1.3 (SD, 0.5) in group A and 8 (SD, 2 times) in group B (P < 0.001). The total access time was 11 minutes (SD, 2 minutes) in group A and 28 minutes (SD, 5 minutes) in group B (P < 0.001). CONCLUSIONS PELD using the fluoroscopy-based navigation system showed lower operative, fluoroscopy, and access time compared with conventional techniques. In addition, fewer fluoroscopy images and access attempts were made in the navigation group. These data suggest that this novel technique reduces fluoroscopy and operation time and may reduce risks of repeated surgical access attempts.
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Hey HWD, Luo N, Chin SY, Lau ETC, Wang P, Kumar N, Lau LL, Ruiz JN, Thambiah JS, Liu KPG, Wong HK. The Predictive Value of Preoperative Health-Related Quality-of-Life Scores on Postoperative Patient-Reported Outcome Scores in Lumbar Spine Surgery. Global Spine J 2018; 8:156-163. [PMID: 29662746 PMCID: PMC5898672 DOI: 10.1177/2192568217701713] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
STUDY DESIGN A single-center, retrospective cohort study. OBJECTIVE To predict patient-reported outcomes (PROs) using preoperative health-related quality-of-life (HRQoL) scores by quantifying the correlation between them, so as to aid selection of surgical candidates and preoperative counselling. METHODS All patients who underwent single-level elective lumbar spine surgery over a 2-year period were divided into 3 diagnosis groups: spondylolisthesis, spinal stenosis, and disc herniation. Patient characteristics and health scores (Oswestry Low Back Pain and Disability Index [ODI], EQ-5D, and Short Form-36 version 2 [SF-36v2]) were collected at 6 and 24 months and compared between the 3 diagnosis groups. Multivariate modelling was performed to investigate the predictive value of each parameter, particularly preoperative ODI and EQ-5D, on postoperative ODI and EQ-5D scores for all the patients. RESULTS ODI and EQ-5D at 6 and 24 months improved significantly for all patients, especially in the disc herniation group, compared to the baseline. The magnitude of improvement in ODI and EQ-5D was predictable using preoperative ODI, EQ-5D, and SF-36v2 Mental Component Score. At 6 months, 1-point baseline ODI predicts for 0.7-point increase in changed ODI, and a 0.01-point increase in baseline EQ-5D predicts for 0.01-point decrease in changed EQ-5D score. At 24 months, 1-point baseline ODI predicts for 1-point increase in changed ODI, and a 0.01-point increase in baseline EQ-5D predicts for 0.009-point decrease in changed EQ-5D. A younger age is shown to be a positive predictor of ODI at 24 months. CONCLUSIONS Poorer baseline health scores predict greater improvement in postoperative PROs at 6 and 24 months after the surgery. HRQoL scores can be used to decide on surgery and in preoperative counselling.
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Affiliation(s)
- Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore,Hwee Weng Dennis Hey, University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, 1E Kent Ridge Road, NUHS Tower Block Level 11, 119228, Singapore.
| | - Nan Luo
- National University of Singapore, Singapore
| | | | - Eugene Tze Chun Lau
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Pei Wang
- National University of Singapore, Singapore
| | - Naresh Kumar
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Leok-Lim Lau
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - John Nathaniel Ruiz
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Joseph Shanthakumar Thambiah
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Ka-Po Gabriel Liu
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
| | - Hee-Kit Wong
- University Orthopaedics, Hand and Reconstructive Microsurgery Cluster, National University Health System, Singapore
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Kapetanakis S, Giovannopoulou E, Charitoudis G, Kazakos K. Health-related quality of life (HRQoL) following transforaminal percutaneous endoscopic discectomy (TPED) for lumbar disc herniation: A prospective cohort study - early results. J Back Musculoskelet Rehabil 2017; 30:1311-1317. [PMID: 28946526 DOI: 10.3233/bmr-169702] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Lumbar discectomy is among the most frequently performed procedures in spinal surgery. Transforaminal percutaneous endoscopic discectomy (TPED) is a minimally invasive technique that gains ground among surgeons in the recent years. TPED has been studied in terms of effectiveness, however little is known about its overall impact on health-related quality of life (HRQoL) of the patients. OBJECTIVE To investigate the progress of HRQoL following TPED. PATIENTS AND METHODS Seventy-six (76) patients were enrolled in the study. Mean age was 56.5 ±12.1 years with 38 (50%) males and 38 (50%) females. All patients underwent TPED at L3-L4 (27.6%), L4-L5 (52.6%) and L5-S1 (19.7%). SF-36 was used for the assessment of HRQoL preoperatively and at 6 weeks, at 3, 6 and 12 months after the procedure. RESULTS All aspects of SF-36 questionnaire showed statistically significant improvement one year after the procedure (p< 0.001). Role limitations due to physical problems, bodily pain and role limitations due emotional problems showed the highest improvement, followed by physical functioning, vitality, social functioning, mental health and general health. CONCLUSIONS TPED for lumbar disc herniation is associated with significant improvement in all aspects of health-related quality of life within 6 weeks postoperatively and the improvement remains significant one year after surgery, as measured by the SF-36 questionnaire.
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Affiliation(s)
- S Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, PC 57001, Greece
| | - E Giovannopoulou
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, PC 57001, Greece
| | - G Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, PC 57001, Greece
| | - K Kazakos
- Department of Orthopaedic Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, PC 68100, Greece
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Abstract
BACKGROUND Lumbar disc herniation is a major cause of back pain and sciatica. The surgical management of lumbar disc prolapse has evolved from exploratory laminectomy to percutaneous endoscopic discectomy. Percutaneous endoscopic discectomy is the least invasive procedure for lumbar disc prolapse. The aim of this study was to analyze the clinical outcome, quality of life, neurologic function, and complications. MATERIALS AND METHODS One hundred patients with lumbar disc prolapse who were treated with percutaneous endoscopic discectomy from May 2012 to January 2014 were included in this retrospective study. Clinical followup was done at 1 month, 3 months, 6 months, 1 year, and at yearly interval thereafter. The outcome was assessed using modified Macnab's criteria, visual analog scale, and Oswestry Disability Index. RESULTS The mean followup period was 2 years (range 18 months - 3 years). Transforaminal approach was used in 84 patients, interlaminar approach in seven patients, and combined approach in nine patients. An excellent outcome was noted in ninety patients, good outcome in six patients, fair result in two patients, and poor result in two patients. Minor complications were seen in three patients, and two patients had recurrent disc prolapse. Mean hospital stay was 1.6 days. CONCLUSIONS Percutaneous endoscopic lumbar discectomy is a safe and effective procedure in lumbar disc prolapse. It has the advantage that it can be performed on a day care basis under local anesthesia with shorter length of hospitalization and early return to work thus improving the quality of life earlier. The low complication rate makes it the future of disc surgery. Transforaminal approach alone is sufficient in majority of cases, although 16% of cases required either percutaneous interlaminar approach or combined approach. The procedure definitely has a learning curve, but it is acceptable with adequate preparations.
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Affiliation(s)
- Kanthila Mahesha
- Maithri Speciality Clinics, Bendoorwell, Mangalore, Karnataka, India,Address for correspondence: Dr. Kanthila Mahesha, Maithri Speciality Clinics, Bendoorwell, Mangalore - 575 002, Karnataka, India. E-mail:
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15
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Kapetanakis S, Giovannopoulou E, Thomaidis T, Charitoudis G, Pavlidis P, Kazakos K. Transforaminal Percutaneous Endoscopic Discectomy in Parkinson Disease: Preliminary Results and Short Review of the Literature. KOREAN JOURNAL OF SPINE 2016; 13:144-150. [PMID: 27799995 PMCID: PMC5086467 DOI: 10.14245/kjs.2016.13.3.144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 12/18/2022]
Abstract
Objective To study the effectiveness of Transforaminal Percutaneous Endoscopic Discectomy (TPED) for lumbar disc herniation in patients with Parkinson disease (PD). Methods Fifteen patients diagnosed with PD and lumbar disc hernia were recruited to the study. All patients underwent TPED. Mean age was 61.27±6 years, with 8 male (53.3%) and 7 female patients (46.7%). Level of operation was L3-4 (33.3%), L4-5 (33.3%) and L5-S1 (33.3%). Visual analogue scale (VAS) for leg pain and Oswestry Disabillity Index (ODI) for back pain, as well as the Medical Outcomes Study Questionnaire Short-Form 36 Health Survey (SF-36) for health-related quality of life (HRQoL) were assessed right before surgery and at 6 weeks, 3, 6, and 12 months after surgery. Results VAS and ODI showed significant (p<0.005) reduction one year after TPED, with a percentage improvement of 83.9% and 79.4%, respectively. Similarly, all aspects of quality of life (SF-36) were significantly (p<0.005) improved 1 year after the procedure. Bodily pain and role physical demonstrated the highest increase followed by role emotional, physical function, social function, vitality, mental health, and general health. Beneficial impact of TPED on clinical outcome and HRQoL was independent of gender and operated level. Conclusion TPED is effective in reducing lower limb symptoms and low back pain in patients with lumbar disc hernia, suffering from PD. Positive effect of endoscopy is, also, evident in HRQoL of those patients one year after the procedure.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Eirini Giovannopoulou
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Triphonas Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - George Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Pavlos Pavlidis
- Laboratory of Forensic Sciences, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - Konstantinos Kazakos
- Department of Orthopaedic Surgery, University Hospital of Alexandroupolis, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
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Shriver MF, Xie JJ, Tye EY, Rosenbaum BP, Kshettry VR, Benzel EC, Mroz TE. Lumbar microdiscectomy complication rates: a systematic review and meta-analysis. Neurosurg Focus 2016; 39:E6. [PMID: 26424346 DOI: 10.3171/2015.7.focus15281] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.
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Affiliation(s)
| | - Jack J Xie
- Department of Physiology and Biophysics, Case Western Reserve University
| | | | | | | | | | - Thomas E Mroz
- Center for Spine Health, and.,Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
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Snowdon M, Peiris CL. Physiotherapy Commenced Within the First Four Weeks Post–Spinal Surgery Is Safe and Effective: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2016; 97:292-301. [DOI: 10.1016/j.apmr.2015.09.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 08/24/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
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Gotecha S, Ranade D, Patil SV, Chugh A, Kotecha M, Sharma S, Punia P. The role of transforaminal percutaneous endoscopic discectomy in lumbar disc herniations. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2016; 7:217-223. [PMID: 27891030 PMCID: PMC5111322 DOI: 10.4103/0974-8237.193267] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To study 1)the efficacy of transforaminal percutaneous endoscopic lumbar discectomy in lumbar disc herniations.2) limitations and advantages of the surgical procedure. 3)morbidity and complications associated with the procedure. MATERIALS AND METHODS This study was carried out on 120 patients who had single level herniated disc Pre-operative assessment of VAS and MSS scoring systems were documented one day prior to surgery. Post operative results were determined by MacNab criteria and by modified Suezawa and Schreiber clinical scoring system (MSS score). RESULTS Maximum patients were in the age group of 31 to 40 years and 83.43% of the patients were males. 80% patients had lumbar disc herniation at L4-L5 level, The mean operative time of endoscopic discectomy was 52.28 minutes and the mean hospital stay was 2.1days.8 cases of L5-S I were abandoned due to high iliac bone and hence their disc could not be accessed. Out of 112 patients who underwent operation, 2 patients developed discitis and 1 was found to have dysesthesia. Also recurrent prolapsed intervertebral disc was seen in 6 cases The mean preoperative and 6 months follow-up VAS score was 8.4 and 1.89 respectively. Mean preoperative and 6 months follow-up Modified Suezawa And Schreiber Clinical Scoring System(MSS Score) was 3.47 and 7.92 respectively. MSS score showed excellent and good outcome in 82.12% patients and Modified Macnab Criteria showed excellent and good outcome in 89.3% patients at 6months follow-up. CONCLUSION TPELD can be a reasonable alternative to conventional microscopic discectomy for the treatment of patients with LDH. We also conclude that TPELD is not an effective procedure for L5-S 1 disc and an open procedure should be opted for better outcomes.
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Affiliation(s)
- Sarang Gotecha
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Deepak Ranade
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Sujay Vikhe Patil
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Ashish Chugh
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Megha Kotecha
- Department of Ophthalmology, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Shrikant Sharma
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
| | - Prashant Punia
- Department of Neurosurgery, Dr. D. Y. Patil Medical College, Pune, Maharashtra, India
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Parker SL, Mendenhall SK, Godil SS, Sivasubramanian P, Cahill K, Ziewacz J, McGirt MJ. Incidence of Low Back Pain After Lumbar Discectomy for Herniated Disc and Its Effect on Patient-reported Outcomes. Clin Orthop Relat Res 2015; 473:1988-99. [PMID: 25694267 PMCID: PMC4419014 DOI: 10.1007/s11999-015-4193-1] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term postdiscectomy degenerative disc disease and low back pain is a well-recognized disorder; however, its patient-centered characterization and quantification are lacking. QUESTIONS/PURPOSES We performed a systematic literature review and prospective longitudinal study to determine the frequency of recurrent back pain after discectomy and quantify its effect on patient-reported outcomes (PROs). METHODS A MEDLINE search was performed to identify studies reporting on the frequency of recurrent back pain, same-level recurrent disc herniation, and reoperation after primary lumbar discectomy. After excluding studies that did not report the percentage of patients with persistent back or leg pain more than 6 months after discectomy or did not report the rate of same level recurrent herniation, 90 studies, which in aggregate had evaluated 21,180 patients, were included in the systematic review portion of this study. For the longitudinal study, all patients undergoing primary lumbar discectomy between October 2010 and March 2013 were enrolled into our prospective spine registry. One hundred fifteen patients were more than 12 months out from surgery, 103 (90%) of whom were available for 1-year outcomes assessment. PROs were prospectively assessed at baseline, 3 months, 1 year, and 2 years. The threshold of deterioration used to classify recurrent back pain was the minimum clinically important difference in back pain (Numeric Rating Scale Back Pain [NRS-BP]) or Disability (Oswestry Disability Index [ODI]), which were 2.5 of 10 points and 20 of 100 points, respectively. RESULTS SYSTEMATIC REVIEW The proportion of patients reporting short-term (6-24 months) and long-term (> 24 months) recurrent back pain ranged from 3% to 34% and 5% to 36%, respectively. The 2-year incidence of recurrent disc herniation ranged from 0% to 23% and the frequency of reoperation ranged from 0% to 13%. PROSPECTIVE STUDY At 1-year and 2-year followup, 22% and 26% patients reported worsening of low back pain (NRS: 5.3 ± 2.5 versus 2.7 ± 2.8, p < 0.001) or disability (ODI%: 32 ± 18 versus 21 ± 18, p < 0.001) compared with 3 months. CONCLUSIONS In a systematic literature review and prospective outcomes study, the frequency of same-level disc herniation requiring reoperation was 6%. Two-year recurrent low back pain may occur in 15% to 25% of patients depending on the level of recurrent pain considered clinically important, and this leads to worse PROs at 1 and 2 years postoperatively.
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Affiliation(s)
- Scott L. Parker
- />Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Stephen K. Mendenhall
- />Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Saniya S. Godil
- />Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Priya Sivasubramanian
- />Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN USA
| | - Kevin Cahill
- />Carolina Neurosurgery & Spine Associates, 225 Baldwin Avenue, Charlotte, NC 28204 USA
| | - John Ziewacz
- />Carolina Neurosurgery & Spine Associates, 225 Baldwin Avenue, Charlotte, NC 28204 USA
| | - Matthew J. McGirt
- />Carolina Neurosurgery & Spine Associates, 225 Baldwin Avenue, Charlotte, NC 28204 USA
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Gore S, Yeung A. The "inside out" transforaminal technique to treat lumbar spinal pain in an awake and aware patient under local anesthesia: results and a review of the literature. Int J Spine Surg 2014; 8:14444-1028. [PMID: 25694940 PMCID: PMC4325508 DOI: 10.14444/1028] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Surgical management of back and leg pain is evolving and changing due to a better understanding of the patho-anatomy well correlated with its pathophysiology. Pain is better understood with in vivo visualization and probing of the pain generators using an endoscopic access rather than just relying on symptoms diagram and image correlation. This has resulted in a shared decision making involving patient and surgeon, focused on a broader spectrum of surgical as well as non-surgical treatments, and not just masking the pain generator. It has moved away from decisions based on diagnostic images alone, that, while noting the image alterations, cannot explain the pain experienced by each individual as images do not always show variations in nerve supply and patho-anatomy. The ability to isolate and visualize "pain" generators in the foramen and treating persistent pain by visualizing inflammation and compression of nerves, serves as the basis for transforaminal endoscopic (TFE) surgery. This has also resulted in better pre surgical planning with more specific and defined goals in mind. The "Inside out" philosophy of TFE surgery is safe and precise. It provides basic access to the disc and foramen to cover a large spectrum of painful pathologies.
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Yoon SM, Ahn SS, Kim KH, Kim YD, Cho JH, Kim DH. Comparative Study of the Outcomes of Percutaneous Endoscopic Lumbar Discectomy and Microscopic Lumbar Discectomy Using the Tubular Retractor System Based on the VAS, ODI, and SF-36. KOREAN JOURNAL OF SPINE 2012; 9:215-22. [PMID: 25983818 PMCID: PMC4431005 DOI: 10.14245/kjs.2012.9.3.215] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 09/10/2012] [Accepted: 09/24/2012] [Indexed: 11/19/2022]
Abstract
Objective Percutaneous endoscopic lumbar discectomy (PELD) and microdiscectomy with the microscope endoscopic tubular retractor system(METRx-MD) are considered popular minimally invasive surgery (MIS) methods for the treatment of lumbar disc herniation. Many authors have also reported good clinical outcomes of these methods, but there are few comparative studies of them. This report compares the clinical outcomes of PELD and METRx-MD for lumbar disc herniation as MIS methods and discusses the efficacy of PELD. Methods Seventy-two patients who had undergone single-level unilateral discectomy using two different methods, PELD and METRx-MD, between 2009 and 2011 were given a follow-up examination prospectively. Thirty-seven of these patients underwent discectomy using PELD, and the remaining 35 patients underwent discectomy using METRx-MD. In addition to the general parameters, clinical outcomes were assessed as specific parameters using the Visual Analogue Scale (VAS) score, the Oswestry Disability Index (ODI), the Short-form 36 (SF-36), and the return-to-work time. Results Sixty-seven percent (25/37) of the patients in the PELD group and 74%(26/35) in the METRx-MD group were included in follow-up more than 6 months post-operatively. The mean improvements in the VAS scores for the back pain, leg pain, and ODI were 2.6, 4.8, and 30.1% for the PELD group and 2.8, 4.6, and 33.2% for the METRx-MD group, respectively. The SF-36 physical health component subscale score improved from 40.6 pre-operatively to 68.3 at the last follow-up for the PELD group post-operatively, and from 48.5 to 65.1 in the mental component subscale (METRx-MD group: from 34.4 to 66.5 and from 44.87 to 56.7). Complications occurred in 3/37 patients in the PELD group and in 2/35 patients in the METRx-MD group in the peri-operative period. The mean return-to-work times were 37.5 days in the PELD group and 42.5 days in the METRx-MD group. Conclusion The outcomes for the PELD group are comparable to those for the METRx-MD group. It can thus be concluded that PELD for lumbar disk herniations may be performed safely and effectively. Also, PELD can be considered one of the treatment modalities of lumbar disk herniation.
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Affiliation(s)
- Sang Mok Yoon
- Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Soon-Seob Ahn
- Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Ki Hong Kim
- Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Young Don Kim
- Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Jae Hoon Cho
- Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Dae-Hyun Kim
- Department of Neurosurgery, College of Medicine, Catholic University of Daegu, Daegu, Korea
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Gibson JNA, Cowie JG, Iprenburg M. Transforaminal endoscopic spinal surgery: the future 'gold standard' for discectomy? - A review. Surgeon 2012; 10:290-6. [PMID: 22705355 DOI: 10.1016/j.surge.2012.05.001] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2011] [Revised: 03/05/2012] [Accepted: 05/09/2012] [Indexed: 12/27/2022]
Abstract
BACKGROUND Lumbar disc prolapse is common and the primary method of care in most centres is still open discectomy facilitated by microscope or loupe magnification and illumination. Hospitalisation may be less than 24 h, but post-operative pain usually requires an overnight stay. This review describes transforaminal endoscopic spinal surgery (TESS) using HD-video technology, that is generally performed as a day case procedure under sedation or light general anaesthesia, and collates the evidence comparing the technique to microdiscectomy. METHODS The method of TESS is described and an electronic literature search performed to identify papers reporting clinical outcomes. International data were translated where necessary and proceedings' abstracts included. In addition, papers held by the authors and colleagues in personal libraries were carefully cross-referenced to the obtained database. RESULTS Analysis of the data supports the use of a transforaminal endoscopic approach to the lumbar intervertebral disc and suggests that outcomes following surgery are at least equivalent to those following microdiscectomy. Significant cost-savings in terms of in-patient stay may be generated. In addition, there is also some evidence supporting endoscopic surgery for relief of foraminal stenosis. CONCLUSION Based on current evidence there are good arguments supporting a more wide-spread adoption of transforaminal endoscopic surgery for the treatment of lumbar disc prolapse with or without foraminal stenosis.
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Affiliation(s)
- J N Alastair Gibson
- Department of Orthopaedic Surgery, The Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh EH16 4SU, United Kingdom.
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