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Li Z, Yang H, Zhang Y, Han C, Liu Y, Guan L, Yang J, Hai Y, Pan A. Percutaneous endoscopic transforaminal discectomy and unilateral biportal endoscopic discectomy for lumbar disc herniation: a comparative analysis of learning curves. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:2154-2165. [PMID: 38727735 DOI: 10.1007/s00586-024-08293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/14/2024] [Accepted: 04/29/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE The purpose of this study was to investigate the learning curve of percutaneous endoscopic transforaminal discectomy (PETD) and interlaminar unilateral biportal endoscopic discectomy (UBED) in the treatment of lumbar disc herniation (LDH). METHODS Between 2018 and 2023, 120 consecutive patients with lumbar disc herniation (LDH) treated by endoscopic lumbar discectomy were retrospectively included. The PETD group comprised 87 cases, and the UBED group comprised 33 cases. Cumulative sum analysis was used to evaluate the learning curve, with the occurrence of complications or unresolved symptoms defined as surgical failure, and variables of different phases of the learning curve being compared. RESULTS The learning curve analysis identified the cutoff point at 40 cases in the PETD group and 15 cases in the UBED group. In the mastery phase, both PETD and UBED demonstrated a significant reduction in operation times (approximately 38 min for PTED and 49 min for UBED). In both PETD and UBED groups, the surgical failure rates during the learning and mastery phases showed no statistically significant differences. The visual analogue scale at the last follow-up was significantly lower than before surgery in both the PETD and UBED groups. CONCLUSION PETD and UBED surgery are effective in the treatment of LDH with a low incidence of complications. However, achieving mastery in PETD necessitates a learning curve of 40 cases, while UBED requires a minimum of 15 cases to reach proficiency.
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Affiliation(s)
- Zhangfu Li
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Honghao Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yaoshen Zhang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Chaofan Han
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yuzeng Liu
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Li Guan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China
- Center for Spinal Deformity, Capital Medical University, Beijing, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China.
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China.
- Center for Spinal Deformity, Capital Medical University, Beijing, China.
| | - Aixing Pan
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University of China, 8 Gong Ti Nan Road, Chaoyang District, Beijing, 100020, China.
- Joint Laboratory for Research and Treatment of Spinal Cord Injury in Spinal Deformity, Capital Medical University of China, Beijing, China.
- Laboratory for Clinical Medicine, Capital Medical University of China, Beijing, China.
- Center for Spinal Deformity, Capital Medical University, Beijing, China.
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Li T, Jiang Q, Zhong W, Zhu T, Lu Z, Ding Y. One-hole split endoscope versus unilateral biportal endoscopy for lumbar spinal stenosis: a retrospective propensity score study. J Orthop Surg Res 2024; 19:254. [PMID: 38649974 PMCID: PMC11034078 DOI: 10.1186/s13018-024-04743-7] [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: 02/21/2024] [Accepted: 04/16/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The one-hole split endoscopy (OSE) was first proposed and clinically applied in China in 2019. The aim of this study was to compare the clinical efficacy of one-hole split endoscopy (OSE) and unilateral biportal endoscopy (UBE) for treating lumbar spinal stenosis (LSS). METHODS One hundred sixty patients with LSS who met the inclusion from November 2020 to August 2022 were analyzed and divided into OSE and UBE groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the two groups. After matching, surgical outcomes were recorded, and clinical data, including functional scores and imaging findings, were compared. Functional scores included the visual analog scale of leg pain (VAS-LP) and back pain (VAS-BP), the Japanese Orthopedic Association score (JOA), and the Oswestry Disability Index (ODI). Imaging data included dural sac cross-sectional area (DCSA), lumbar range of motion (ROM), and sagittal translation (ST). RESULTS After PSM, 104 LSS patients were included in the study, and all covariates were well-balanced between the two groups. Among the matched patients, the OSE showed advantages over the UBE regarding operative time (62.42 ± 4.86 vs. 68.96 ± 4.56) and incision length (2.30 ± 0.14 vs. 2.70 ± 0.15) (P < 0.001). However, differences between the two groups in intraoperative blood loss, hospital length of stay, and complication rates were not statistically significant (P > 0.05). There was no statistically significant difference regarding VAS-BP, VAS-LP, JOA, and ODI between the two groups (P > 0.05). However, all clinical and functional scores significantly improved postoperatively (P < 0.05). Postoperative DCSA of both groups was significantly found to be improved (P < 0.05), ROM and ST remained within the normal range, and no cases of lumbar instability were recorded. According to the modified MacNab criteria, the excellent and good rates in the OSE and UBE groups were 94.23% and 90.38%, respectively, with no statistically significant difference (P = 0.713). CONCLUSION OSE is an alternative technique to UBE for the treatment of LSS, with similar satisfactory clinical outcomes, shorter operative time, and smaller incision length. Further studies are needed for long-term efficacy.
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Affiliation(s)
- Tusheng Li
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China
| | - Qiang Jiang
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Wei Zhong
- School of Medicine, South China University of Technology, Guangzhou, People's Republic of China
| | - Tengyue Zhu
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Zhengcao Lu
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China
| | - Yu Ding
- Orthopedics of TCM Senior Department, The Sixth Medical Center of PLA General Hospital, 6 Fucheng Road, Haidian District, Beijing, 100048, People's Republic of China.
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
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谭 芳, 张 锋, 韩 帅, 宋 鑫, 袁 云, 王 健. [Analysis of effectiveness of one-hole split endoscopy technique in treatment of lumbar spinal stenosis]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2024; 38:337-341. [PMID: 38500428 PMCID: PMC10982041 DOI: 10.7507/1002-1892.202401042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/18/2024] [Indexed: 03/20/2024]
Abstract
Objective To investigate the effectiveness of one-hole split endoscope (OSE) technique in the treatment of single segment lumbar spinal stenosis (LSS). Methods The clinical data of 32 single segment LSS patients treated with OSE technique for simple spinal canal decompression between January 2022 and December 2022, who met the selection criteria, were retrospectively analysed. There were 18 males and 14 females, the age ranged from 45 to 82 years, with an average of 65.1 years. The disease duration was 9-72 months, with an average of 34.9 months. The surgical segments included L 3, 4 in 3 cases, L 4, 5 in 19 cases, and L 5, S 1 in 10 cases. The incision length, operation time, intraoperative blood loss, intraoperative radiation exposure frequency, postoperative mobilization time, and the area of the patient's lesion segment dural sac before operation and at 1 month after operation were recorded. Low back pain and leg pain were assessed by visual analogue scale (VAS) score before operation and at 3 days, 3 months, and 12 months after operation; functional recovery was assessed by Oswestry disability index (ODI) before operation and at 3 months and 12 months after operation; the effectiveness was assessed by modified MacNab criteria at last follow-up. Results All 32 patients successfully completed the operation, with an average incision length of 2.05 cm, an average operation time of 88.59 minutes, an average intraoperative blood loss of 46.72 mL, an average intraoperative radiation exposure frequency of 3.84 times, and an average postoperative mobilization time of 11.66 hours. All patients were followed up 12-16 months, with an average of 13.5 months. One patient experienced lower limb numbness, pain, and decreased muscle strength after operation, while the remaining patients did not experience complications such as dural tear or important nerve damage. The VAS scores of low back pain and leg pain and ODI in patients at various time points after operation were significantly better than preoperative ones, and each indicator further improved with time. The differences between time points were significant ( P<0.05). At 1 month after operation, the area of the patient's lesion segment dural sac was (123.13±19.66) mm 2, which significantly increased compared to preoperative (51.25±9.50) mm 2 ( t=-18.616, P<0.001). At last follow-up, the improved MacNab criteria were used to evaluate the effectiveness, with 18 cases achieving excellent results, 11 cases being good, and 3 cases being fair, with an excellent and good rate of 90.6%. Conclusion The effectiveness of using OSE technique for simple spinal canal decompression treatment of single segment LSS is satisfactory, with the advantages of minimal surgical trauma and fast recovery.
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Affiliation(s)
- 芳 谭
- 上海市浦东新区人民医院骨科(上海 201299)Department of Orthopedics, Pudong New Area People’s Hospital of Shanghai, Shanghai, 201299, P. R. China
| | - 锋 张
- 上海市浦东新区人民医院骨科(上海 201299)Department of Orthopedics, Pudong New Area People’s Hospital of Shanghai, Shanghai, 201299, P. R. China
| | - 帅 韩
- 上海市浦东新区人民医院骨科(上海 201299)Department of Orthopedics, Pudong New Area People’s Hospital of Shanghai, Shanghai, 201299, P. R. China
| | - 鑫 宋
- 上海市浦东新区人民医院骨科(上海 201299)Department of Orthopedics, Pudong New Area People’s Hospital of Shanghai, Shanghai, 201299, P. R. China
| | - 云华 袁
- 上海市浦东新区人民医院骨科(上海 201299)Department of Orthopedics, Pudong New Area People’s Hospital of Shanghai, Shanghai, 201299, P. R. China
| | - 健 王
- 上海市浦东新区人民医院骨科(上海 201299)Department of Orthopedics, Pudong New Area People’s Hospital of Shanghai, Shanghai, 201299, P. R. China
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Liu C, Zhang W, Wang C, Hu B, Wang K, Feng Y, Li L, Xu W, Si H. Comparison of one-hole split endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar disk herniation: a one-year retrospective cohort study. J Orthop Surg Res 2024; 19:123. [PMID: 38317253 PMCID: PMC10845564 DOI: 10.1186/s13018-024-04574-6] [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: 10/27/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND We aim to compare and assess the surgical parameters and follow-up information of one-hole split endoscopic discectomy (OSE) and microendoscopic discectomy (MED) in the treatment of LDH. METHODS This study included 154 patients with degenerative lumbar disk disease. Sixty-eight patients underwent OSE and 86 patients MED. The VAS score for lower back and lower limb radiation pain, ODI score, modified MacNab score, estimated blood loss (EBL), length of the incision, amount of C-reactive protein, and recurrence and complication rates were examined as indicators for clinical outcomes and adverse events. RESULTS After surgery, the VAS and ODI scores in the two groups significantly decreased. On the third day after surgery, the VAS and ODI scores of the OSE group were significantly better than those of the MED group. The VAS and ODI scores preoperatively and at 1 month, 3 months, 6 months, and 12 months following the procedure did not substantially vary between the two groups. There was less EBL and a shorter incision with OSE than with MED. There was no significant difference in the rate of complications between the two groups. CONCLUSION Compared with MED, OSE is a new alternative option for LDH that can achieve similar and satisfactory clinical outcomes. Furthermore, OSE has many advantages, including less EBL and a smaller incision. Further clinical studies are needed to confirm the effectiveness of OSE.
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Affiliation(s)
- Chen Liu
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Wencan Zhang
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Chongyi Wang
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Bingtao Hu
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Kaibin Wang
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Yunze Feng
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Le Li
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Wanlong Xu
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China.
| | - Haipeng Si
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China.
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