1
|
Fujita M, Inui T, Oshima Y, Iwai H, Inanami H, Koga H. Comparison of the Outcomes of Microendoscopic Discectomy Versus Full-Endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation. Global Spine J 2024; 14:922-929. [PMID: 36134544 PMCID: PMC11192103 DOI: 10.1177/21925682221127997] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Muneyoshi Fujita
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hiroki Iwai
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Neurosurgery, Iwai FESS Clinic, Tokyo, Japan
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| |
Collapse
|
2
|
Serifoglu L, Etli MU. Transforaminal Epidural Injection for Far Lateral Lumbar Disc Herniations: An Alternative to Surgery or Just a Delay? Cureus 2024; 16:e52530. [PMID: 38371082 PMCID: PMC10874465 DOI: 10.7759/cureus.52530] [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] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
OBJECTIVE Far lateral lumbar disc herniations (FLLDH) are known for causing severe and persistent radicular pain due to direct nerve root and dorsal root ganglion compression. This study evaluates the effectiveness of transforaminal epidural steroid injection (TFSI) in patients with FLLDH, assessing its role as a potential alternative to surgery. METHODS The study retrospectively analyzed 42 patients with radicular pain caused by FLDH, confirmed via lumbar magnetic resonance imaging, who had not benefited from conservative treatment. All patients underwent TFSI, and their pre-treatment Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) scores were compared with scores at one, two, and three months post-procedure. RESULTS The study group comprised 19 males (45.23%) and 23 females (54.77%), with a mean age of 51.9 ± 11.63 years (range 29-76 years). The most common herniation levels were L4-L5 (22 patients), followed by L5-S1 (15 patients) and L3-L4 (five patients). The mean VAS score decreased significantly from 8.58 ± 0.63 to 2.89 ± 1.87 over three months (p = 0.001). Similarly, the mean ODI score significantly reduced from 61.29 ± 6.72 to 16.88 ± 11.25 (p = 0.001). However, eight of the 42 patients (19.04%) underwent surgery within three months due to lack of benefit from TFSI. CONCLUSION Our study sheds light on the significant potential of TFSI as a treatment option for FLLDH. The marked improvement in pain and functional capacity, as evidenced by the substantial decrease in VAS and ODI scores, suggests that TFSI can be an effective non-surgical intervention for a majority of patients suffering from FLLDH. However, a notable proportion of patients may still require surgery, indicating that TFSI might not be a definitive alternative but can be an effective interim treatment in managing FLLDH.
Collapse
Affiliation(s)
- Luay Serifoglu
- Department of Neurosurgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| | - Mustafa U Etli
- Department of Neurosurgery, University of Health Sciences, Umraniye Training and Research Hospital, Istanbul, TUR
| |
Collapse
|
3
|
Takebayashi K, Oshima Y, Fujita M, Inui T, Iwai H, Inanami H, Koga H. Comparison of the Interlaminar and Transforaminal Approaches for Full-endoscopic Discectomy for the Treatment of L4/5 Lumbar Disc Herniation. Neurol Med Chir (Tokyo) 2023; 63:313-320. [PMID: 37164700 PMCID: PMC10406458 DOI: 10.2176/jns-nmc.2022-0357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 03/06/2023] [Indexed: 05/12/2023] Open
Abstract
This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH).A retrospective study of patients with L4/5 LDH treated with interlaminar endoscopic lumbar discectomy (IELD, n = 19) or transforaminal endoscopic lumbar discectomy (TELD, n = 105) was conducted. Patient background, radiological findings, and operative data were collected. Oswestry Disability Index (ODI) and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 1 and 2 years postoperatively.Although ODI and EQ-5D scores 1 and 2 years postoperatively improved statistically in the IELD and TELD groups, there were no statistical differences between the groups. IELD was predominantly performed in patients who were taller and heavier. The mean operative times and the frequency of laminectomy for IELD and TELD were 67.2 and 44.6 min and 63.2 and 17.1%, respectively (P < 0.001). The radiological findings showed that the concave configuration of the L4 lamina, interlaminar space width, and foraminal width were statistically different between the groups. There were no complications in either of the groups. Reoperation was required for recurrence in two and five patients in the IELD and TELD groups (P = 0.29), respectively.Operative outcomes were identical between the two groups. Although the operative time was longer in the IELD group, both approaches were safely and effectively performed. Depending on the patient's physique and preoperative radiological findings, the more suitable approach for L4/5 LDH should be chosen.
Collapse
Affiliation(s)
- Kento Takebayashi
- Department of Neurosurgery, Iwai FESS Clinic
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital
| | - Muneyoshi Fujita
- Department of Neurosurgery, Iwai FESS Clinic
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Orthopaedic Surgery, Teikyo University School of Medicine
| | - Takahiro Inui
- Department of Orthopaedic Surgery, Teikyo University School of Medicine
| | - Hiroki Iwai
- Department of Neurosurgery, Iwai FESS Clinic
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital
| | - Hirohiko Inanami
- Department of Neurosurgery, Iwai FESS Clinic
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital
| | - Hisashi Koga
- Department of Neurosurgery, Iwai FESS Clinic
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital
- Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital
| |
Collapse
|
4
|
Musharbash FN, Lee SH. A Modified Endoscopic Access for Lumbar Foraminal Pathologies; Posterolateral “Intertransverse” Endoscopic Approach to Minimize Postoperative Dysesthesia Following Transforaminal Approach. Neurospine 2023; 20:150-157. [PMID: 37016863 PMCID: PMC10080430 DOI: 10.14245/ns.2346076.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 03/01/2023] [Indexed: 04/03/2023] Open
Abstract
Objective: To present an innovative, modified endoscopic approach for foraminal/extraforaminal pathologies, to reduce postoperative dysesthesia (POD) following the conventional transforaminal endoscopic approach (the access angle more than 45° from the midline), since POD is one of the major documented disadvantages that may compromise patient satisfaction.Methods: We introduce a modified posterolateral technique, termed the intertransverse approach, utilizing a steeper access angle less than 25° through the intertransversarii muscle and the intertransverse space with expanding Kambin triangle via lateral facetectomy/foraminoplasty, to reduce dorsal root ganglion/exiting nerve root irritation under direct visualization and lower the incidence of POD. Consecutive patients undergoing endoscopic spine surgery via the intertransverse approach for foraminal and/or extraforaminal disc herniations or bony stenosis were retrospectively reviewed. Clinical outcomes were reviewed with the primary outcome being POD.Results: Twenty-two patients were included in the review. Patients showed significantly improved clinical outcomes (visual analogue scale leg and back pain and Oswestry Disability Index) postoperatively. There was a low rate of dorsal root ganglion (DRG)-related POD (9.1%, 2 of 22) that was minimal and resolved soon.Conclusion: The inter-transverse endoscopic approach is feasible for lumbosacral foraminal and extraforaminal decompression with significantly improved clinical outcomes and the added advantage of a low rate of DRG-related POD compared to traditionally reported rates in the literature for the conventional transforaminal approach.
Collapse
Affiliation(s)
- Farah N. Musharbash
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Sang Hun Lee
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
- Corresponding Author Sang Hun Lee The Johns Hopkins University, 601 North Caroline Street, Suite 5250, Baltimore, MD 21287, USA
| |
Collapse
|
5
|
Jiang Y, Shi K, Zhou L, He M, Zhu C, Wang J, Li J, Li Y, Liu L, Sun D, Feng G, Yi Y, Zhang L. 3D-printed auxetic-structured intervertebral disc implant for potential treatment of lumbar herniated disc. Bioact Mater 2023; 20:528-538. [PMID: 35846840 PMCID: PMC9253410 DOI: 10.1016/j.bioactmat.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/26/2022] [Accepted: 06/06/2022] [Indexed: 11/27/2022] Open
Abstract
In this study, a novel artificial intervertebral disc implant with modified “Bucklicrystal” structure was designed and 3D printed using thermoplastic polyurethane. The new implant has a unique auxetic structure with building blocks joined “face-to-face”. The accompanied negative Poisson’s ratio enables its excellent energy absorption and stability under compression. The deformation and load distribution behavior of the implant under various loading conditions (bending, torsion, extension and flexion) has been thoroughly evaluated through finite element method. Results show that, compared to natural intervertebral disc and conventional 3D implant, our new implant exhibits more effective stress transfer and attenuation under practical loading conditions. The implant's ability to contract laterally under compression can be potentially used to alleviate the symptoms of lumbar disc herniation. Finally, the biocompatibility of the implant was assessed in vitro and its ability to restore the physiological function of the disc segment was validated in vivo using an animal model. Auxetic-structured IVD implant features negative Poisson's ratio (NPR) behavior. Modified “Bucklicrystal”structure exhibits better energy absorption and stability. The stress effectively and evenly transfers/attenuates in the auxetic implant. Auxetic implant potentially alleviates the symptoms of lumbar disc herniation.
Collapse
Affiliation(s)
- Yulin Jiang
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Kun Shi
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Luonan Zhou
- School of Materials Science and Engineering, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Miaomiao He
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Ce Zhu
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Jingcheng Wang
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Jianhua Li
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Yubao Li
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Limin Liu
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
| | - Dan Sun
- Advanced Composite Research Group (ACRG), School of Mechanical and Aerospace Engineering, Queen's University Belfast, BT9 5AH, UK
| | - Ganjun Feng
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
- Corresponding author
| | - Yong Yi
- School of Materials Science and Engineering, Southwest University of Science and Technology, Mianyang, 621010, China
| | - Li Zhang
- Analytical and Testing Center, Department of Orthopedic Surgery and Orthopedic Research Institute, Sichuan University, Chengdu, 610065, China
- Corresponding author.
| |
Collapse
|
6
|
Kumar VA, Reddy R, Yerramneni VK, Kolpakawar S, Kumar KV, Pratyusha P. Minimally Invasive Discectomy and Decompression for Lumbar Spine using Tubular Retractor System: Technique, Learning Curve and Outcomes. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1722825] [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] Open
Abstract
Abstract
Objective To study the indications, technical nuances, learning curve, and outcomes associated with minimally invasive tubular discectomy of spine (MITDS) and minimally invasive tubular decompression (MITD) using the tubular retractor system and compare the outcomes with open microdiscectomy and open decompression.
Materials and Methods All patients who underwent MITDS and MITD received a trial of conservative management for 6 weeks prior to surgery. Patients who had undergone open microdiscectomy and open decompression during the same period were used as controls. Operating time, intraoperative blood loss, preop and postop visual analogue scale (VAS) scores, preop and postop Oswestry disability index (ODI) scores, duration of hospital stay, complications, and need for redo surgery were analyzed.
Results Thirty-two patients who underwent MITDS and 8 patients who underwent MITD were compared with an equal number of patients who underwent open microdiscectomy and open decompression, respectively. MITDS and MITD were associated with shorter hospital stay. Short-term pain outcome was better in MITDS and MITD group, although it was not statistically significant in MITD group. Functional outcome measured in terms of ODI at 6 months was not statistically significant between minimally invasive and open procedures.
Conclusion Both MITDS and MITD have a significant learning curve and have a distinct advantage of shorter hospital stay. MITDS has the distinct advantage of better short-term pain relief compared with open procedures. For MITD, comparison of short-term pain relief requires a larger sample size. To establish long-term advantages of MITDS and MITD, larger sample size and long-term follow-up are needed.
Collapse
Affiliation(s)
- V A Kumar
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - Ramanadha Reddy
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | | | - Swapnil Kolpakawar
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - K.S. Vishwa Kumar
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - Patlolla Pratyusha
- Department of Neurosurgery, Nizam’s Institute of Medical Sciences, Panjagutta, Hyderabad, India
| |
Collapse
|
7
|
Franco D, Mouchtouris N, Gonzalez GA, Hines K, Mahtabfar A, Sivaganesan A, Jallo J. A Review of Endoscopic Spine Surgery: Decompression for Radiculopathy. Curr Pain Headache Rep 2022; 26:183-191. [PMID: 35122596 DOI: 10.1007/s11916-022-01017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW With this manuscript the authors sought to write a succinct review of the origins, as well as the latest advancements in endoscopic spine surgery to serve as a reference frame for physicians looking to learn this approach. RECENT FINDINGS At its infancy, the indications for posterolateral and transforaminal endoscopic decompression remained narrow, which prevented the procedure from gaining rapid traction during those days. However, more recently the tides have turned and an increasing number of surgeons are starting to adopt this technique given all its advantages. With the advent of higher quality camera systems and instruments, indications to use a minimally invasive option have gotten significantly broader. The most basic indication for the use of this technology is a soft disc herniation causing compromise of a neural structure that has failed to be managed successfully with non-surgical therapies. The use of endoscopic techniques provides significant advantages to patient outcomes and patient recovery. Endoscopic procedures should not be used as a blanket approach to nerve root decompression, as they certainly have limitations. Most contraindications to this procedure are relative and serve mostly as points to consider when selecting the methods to address neural compression. As these techniques become more widely accepted, we expect its reach and indications to continue to broaden and diversify. The full integration of navigation technologies will likely leapfrog this procedure into the mainstream use.
Collapse
Affiliation(s)
- Daniel Franco
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA.
| | - Nikolaos Mouchtouris
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Glenn A Gonzalez
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Kevin Hines
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Aria Mahtabfar
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Ahilan Sivaganesan
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| | - Jack Jallo
- Department of Neurosurgery, Thomas Jefferson University Hospitals, 909 Walnut Street, Room 320L, Philadelphia, PA, 19147, USA
| |
Collapse
|
8
|
Zou F, Zhang L, Zou X, Huang J, Nie C, Jiang J, Guo C, Wang H, Ma X, Ji M. Differential characterization of lumbar spine associated tissue histology with nonlinear optical microscopy. BIOMEDICAL OPTICS EXPRESS 2022; 13:474-484. [PMID: 35154886 PMCID: PMC8803016 DOI: 10.1364/boe.446351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 12/12/2021] [Accepted: 12/13/2021] [Indexed: 06/14/2023]
Abstract
Percutaneous endoscopic lumbar discectomy (PELD) is the major effective treatment for lumbar disc herniation, and rapid histological identification of dissected tissue is critical to guide the discectomy. In this work, we revealed the histological features of different types of peridural tissues of the lumbar spine by label-free multi-modal nonlinear optical microscopy. Stimulated Raman scattering (SRS) was used to extract lipid and protein distributions, while second harmonic generation (SHG) and two-photon excited fluorescence (TPEF) signals were applied to image the collagen and elastin fibers at the same time. Our results demonstrated that the nonlinear optical features of the dura and adjacent soft tissues were significantly different, showing the potentials of our method for intraoperative differentiation of these critical tissues and improving the surgical outcome of PELD.
Collapse
Affiliation(s)
- Fei Zou
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
- These authors contributed equally
| | - Lili Zhang
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Multiscale Research Institute of Complex Systems, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Fudan University, Shanghai 200433, China
- State Key Laboratory of Infrared Physics, Shanghai Institute of Technical Physics, Chinese Academy of Sciences, Shanghai 200083, China
- These authors contributed equally
| | - Xiang Zou
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai 200040, China
- These authors contributed equally
| | - Jing Huang
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Multiscale Research Institute of Complex Systems, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Fudan University, Shanghai 200433, China
| | - Cong Nie
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Jianyuan Jiang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Chongyuan Guo
- Shanghai Starriver Bilingual School, Shanghai 201108, China
| | - Hongli Wang
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Xiaosheng Ma
- Department of Orthopaedics, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Minbiao Ji
- State Key Laboratory of Surface Physics and Department of Physics, Human Phenome Institute, Multiscale Research Institute of Complex Systems, Academy for Engineering and Technology, Key Laboratory of Micro and Nano Photonic Structures (Ministry of Education), Fudan University, Shanghai 200433, China
- Yiwu Research Institute of Fudan University, Chengbei Road, Yiwu City, Zhejiang 322000, China
| |
Collapse
|
9
|
Song Y, Li C, Guan J, Li C, Wu H, Cheng X, Ling B, Zhang J. Outcomes of epidural steroids following percutaneous transforaminal endoscopic discectomy: a meta-analysis and systematic review. Korean J Pain 2022; 35:97-105. [PMID: 34966016 PMCID: PMC8728551 DOI: 10.3344/kjp.2022.35.1.97] [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: 08/24/2021] [Revised: 09/19/2021] [Accepted: 09/27/2021] [Indexed: 11/06/2022] Open
Abstract
Background Percutaneous transforaminal endoscopic discectomy (PTED) has been widely used in the treatment of lumbar degenerative diseases. Epidural injection of steroids can reduce the incidence and duration of postoperative pain in a short period of time. Although steroids are widely believed to reduce the effect of surgical trauma, the observation indicators are not uniform, especially the long-term effects, so the problem remains controversial. Therefore, the purpose of this paper was to evaluate the efficacy of epidural steroids following PTED. Methods We searched PubMed, Embase, and the Cochrane Database from 1980 to June 2021 to identify randomized and non-randomized controlled trials comparing epidural steroids and saline alone following PTED. The primary outcomes included postoperative pain at least 6 months as assessed using a visual analogue scale (VAS) and the Oswestry Disability Index (ODI). The secondary outcomes included length of hospital stay and the time of return to work. Results A total of 451 patients were included in three randomized and two non-randomized controlled trials. The primary outcomes, including VAS and ODI scores, did not differ significantly between epidural steroids following PTED and saline alone. There were no significant intergroup differences in length of hospital stay. Epidural steroids were shown to be superior in terms of the time to return to work (P < 0.001). Conclusions Intraoperative epidural steroids did not provide significant benefits, leg pain control, improvement in ODI scores, and length of stay in the hospital, but it can enable the patient to return to work faster.
Collapse
Affiliation(s)
- Yinghao Song
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Changxi Li
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jingjing Guan
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Cheng Li
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Haisheng Wu
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Xinzhi Cheng
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Bingyu Ling
- Department of Emergency, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| | - Jinglang Zhang
- Department of Pain, Clinical Medical College of Yangzhou University, Northern Jiangsu People's Hospital, Yangzhou, Jiangsu, China
| |
Collapse
|
10
|
Ahn Y, Yoo BR, Jung JM. The irony of the transforaminal approach: A comparative cohort study of transforaminal endoscopic lumbar discectomy for foraminal versus paramedian lumbar disc herniation. Medicine (Baltimore) 2021; 100:e27412. [PMID: 34622848 PMCID: PMC8500638 DOI: 10.1097/md.0000000000027412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 09/17/2021] [Indexed: 01/05/2023] Open
Abstract
Transforaminal endoscopic lumbar discectomy (TELD) is useful for soft lumbar disc herniation (LDH). Although the transforaminal approach can reach the foraminal disc zone, the risk of exiting nerve root irritation along the path is considerable. Few studies have assessed the difficulties of TELD for foraminal LDH. The objective of this study is to compare the clinical results of TELD between foraminal or far-lateral LDH and paramedian LDH.Between June 2016 and July 2017, 135 consecutive patients with single-level LDH were treated with TELD for 2 years. Among them, 25 patients had foraminal or far-lateral LDH (foraminal group), and the remaining 110 patients had central or subarticular LDH (paramedian group). Perioperative data and clinical outcomes were evaluated using the visual analog pain scale, Oswestry Disability Index, and modified Macnab criteria.The foraminal group showed a higher rate of significant access pain (24.00% vs 8.19%, P < .05). The foraminal group also had a longer duration of surgery, length of hospital stay, and return to work (all P < .05). Pain scores and functional status were significantly improved in both groups. Although there were no differences in the outcomes at 2 years postoperatively, early pain and disability at 6 weeks were higher in the foraminal group.Ironically, the early clinical results of TELD for foraminal LDH may be less favorable than those for paramedian LDH. Therefore, great care should be taken during TELD for foraminal or far-lateral LDH.
Collapse
|
11
|
Peredo AP, Gullbrand SE, Mauck RL, Smith HE. A challenging playing field: Identifying the endogenous impediments to annulus fibrosus repair. JOR Spine 2021; 4:e1133. [PMID: 33778407 PMCID: PMC7984000 DOI: 10.1002/jsp2.1133] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/31/2022] Open
Abstract
Intervertebral disc (IVD) herniations, caused by annulus fibrosus (AF) tears that enable disc tissue extrusion beyond the disc space, are very prevalent, especially among adults in the third to fifth decade of life. Symptomatic herniations, in which the extruded tissue compresses surrounding nerves, are characterized by back pain, numbness, and tingling and can cause extreme physical disability. Patients whose symptoms persist after nonoperative intervention may undergo surgical removal of the herniated tissue via microdiscectomy surgery. The AF, however, which has a poor endogenous healing ability, is left unrepaired increasing the risk for re-herniation and pre-disposing the IVD to degenerative disc disease. The lack of understanding of the mechanisms involved in native AF repair limits the design of repair systems that overcome the impediments to successful AF restoration. Moreover, the complexity of the AF structure and the challenging anatomy of the repair environment represents a significant challenge for the design of new repair devices. While progress has been made towards the development of an effective AF repair technique, these methods have yet to demonstrate long-term repair and recovery of IVD biomechanics. In this review, the limitations of endogenous AF healing are discussed and key cellular events and factors involved are highlighted to identify potential therapeutic targets that can be integrated into AF repair methods. Clinical repair strategies and their limitations are described to further guide the design of repair approaches that effectively restore native tissue structure and function.
Collapse
Affiliation(s)
- Ana P. Peredo
- Department of BioengineeringSchool of Engineering and Applied Science, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Sarah E. Gullbrand
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Robert L. Mauck
- Department of BioengineeringSchool of Engineering and Applied Science, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPennsylvaniaUSA
| | - Harvey E. Smith
- McKay Orthopaedic Research Laboratory, Department of Orthopaedic SurgeryPerelman School of Medicine, University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Translational Musculoskeletal Research CenterCorporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
12
|
Full-Endoscopic Lumbar Interbody Fusion for Treating Lumbar Disc Degeneration Involving Disc Height Loss: Technical Report. MEDICINA-LITHUANIA 2020; 56:medicina56090478. [PMID: 32957721 PMCID: PMC7559920 DOI: 10.3390/medicina56090478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 01/06/2023]
Abstract
Background and Objectives: Lumbar disc degeneration (LDD) is the main cause of lower back pain and leads to corresponding disc height loss. Although lumbar interbody fusion (LIF) is commonly used for treating LDD, several different treatment strategies are available. We performed a minimally invasive full-endoscopic LIF (FELIF) using a uniportal full-endoscopic system. Materials and Methods: FELIF was performed for 12 patients with LDD with disc-height loss using a 4.1 mm working channel endoscope and a newly developed slider for cage insertion. The mean age of the patients was 68.3 years; the patients presented with single vertebral level involvement. The Brandner’s disc index was used for evaluating the postoperative increase in the disc height. Preoperative and postoperative leg pain was evaluated using the numerical rating scale (NRS) score. Results: The mean operation time for FELIF was 109.4 min. The mean duration of hospital stay after FELIF was 7.7 days. There were no operative and postoperative complications, even without drainage during the mean follow-up period of 6.2 months (range, 2–10 months). The Brandner’s disc index improved statistically significant (p > 0.01). The mean preoperative and postoperative NRS scores were 6.5 and 1.2, respectively. Conclusions: FELIF using a 4.1 mm working channel endoscope can be used for treating LDD with disc height loss. Radiculopathy caused by foraminal stenosis was the most suitable operative indication for FELIF.
Collapse
|
13
|
Liu Y, Qi Y, Diaty DM, Zheng G, Shen X, Lin S, Chen J, Song Y, Gu X. Treatment for lumbar spinal stenosis secondary to ligamentum flavum hypertrophy using percutaneous endoscopy through interlaminar approach: a retrospective study. J Orthop Surg Res 2020; 15:337. [PMID: 32811508 PMCID: PMC7437061 DOI: 10.1186/s13018-020-01874-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background This paper is to describe percutaneous endoscopy in the treatment of lumbar spinal stenosis secondary to ligamentum flavum hypertrophy targeted and to investigate the efficacy and safety of percutaneous endoscopy in the treatment of this kind of lumbar spinal stenosis in elderly patients. Method A retrospective analysis of 40 elderly patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy admitted between January 2016 and January 2018 was performed. According to different surgical methods, they were divided into two groups: the control group and the endoscopy group (interlaminar approach), 20 people per group. There were 9 males and 11 females in the control group; the age of patients was 65.65 ± 4.44 years, and the average disease duration was 4.55 ± 1.85 years. Besides, there were 10 males and 10 females in the endoscopy group; the age of patients was 67.30 ± 4.23 years, and the average disease duration was 4.95 ± 2.04 years. Collect and count surgical-related indicators, preoperative and postoperative radiologic findings, incision visual analog scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA), and Oswestry disability index (ODI) scores of all patients. Result A series of surgical indicators (including the operation time, the quantity of bleeding, and postoperative hospital stay) in the endoscopy group was significantly lower than that in the control group (p < 0.05). The incision VAS score in the endoscopy group was also significantly lower than that in the control group at each time after surgery (p < 0.05). Besides, compared with the control group, in the endoscopy group, the leg pain VAS score and lumbar ODI score after surgery were significantly decreased (p < 0.05). Compared with the control group, in the endoscopy group, the lumbar JOA score was significantly higher (p < 0.05). Conclusion Percutaneous endoscopic technique is a small trauma, quick recovery, safe, and effective minimally invasive surgery for patients with lumbar spinal stenosis secondary to ligamentum flavum hypertrophy.
Collapse
Affiliation(s)
- Yi Liu
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Yingjie Qi
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Diarra Mohamed Diaty
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Guanglei Zheng
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Xiaoqiang Shen
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Shangben Lin
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Jiaqi Chen
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Yongwei Song
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China
| | - Xiaomin Gu
- Department of Orthopaedics, The Affiliated Hospital of Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, 310000, China.
| |
Collapse
|
14
|
Budisulistyo T, Atmaja F. Percutaneous Discectomy Followed by CESI Might Improve Neurological Disorder of Drop Foot Patients Due to Chronic LDH. Brain Sci 2020; 10:brainsci10080539. [PMID: 32796497 PMCID: PMC7465042 DOI: 10.3390/brainsci10080539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/15/2020] [Accepted: 07/17/2020] [Indexed: 01/23/2023] Open
Abstract
(1) Introduction: Epiconus and conus medullary syndromes that consisted of drop foot, pain, numbness, bladder or bowel dysfunction are serious problems might be caused by lumbar disc(s) herniation (LDH) compression. (2) Objective: To evaluate percutaneous discectomy effectivity for decompressing LDH lesions. (3) Case Report: Three patients suffered from drop feet, numbness, and bowel and bladder problems due to LDH compression. Patient #1 is a male (35 years old, basal metabolism index (BMI) = 23.9), point 1 on manual muscle test (MMT), with protrusion on L3 to S1 discs; Patient #2 is a female (62 years old, BMI = 22.4), point 3 on MMT, with protrusion on L2-4 and L5-S1 discs; Patient #3 is a female (43 years old, BMI = 26.6), point 4 on MMT, with extrusion on T12-L1 and L1-2 and L3-4 protruded discs. Six months follow-up showed of stand and walkability improvement with Patient #1 and #2. Patient #3 showed improvement in bowel and bladder problems within 10 weeks, without suffering of postoperative pain syndromes. (4) Discussion: Patient #1 and #2 showed better outcomes than Patient #3 who affected epiconus and cauda equina syndromes. Triamcinolone and lidocaine have analgesic and anti-inflammatory properties for improving intraepidural circulation adjacent to the lesion sites. (5) Conclusion: Drop foot caused by mechanical compression of LDH ought to be treated immediately. Lateral or posterolateral compression has better outcomes associated with anatomical structures. Discectomy through transforaminal approach that is followed by caudal epidural steroid injection (CESI) under fluoroscopic guidance is a safer and minimally invasive treatment with promising outcomes.
Collapse
Affiliation(s)
- Trianggoro Budisulistyo
- Department of Neurology, Diponegoro Univ/Dr.Kariadi Hospital, Semarang 50244, Indonesia
- Correspondence:
| | - Firmansyah Atmaja
- Indonesian Army Health Center/Pelamonia Hospital, Makassar 90157, Indonesia;
| |
Collapse
|
15
|
Iwai H, Oshima Y, Kitagawa T, Inoue H, Takano Y, Inanami H, Koga H. A less invasive treatment by a full-endoscopic spine surgery for adjacent segment disease after lumbar interbody fusion. JOURNAL OF SPINE SURGERY 2020; 6:472-482. [PMID: 32656385 DOI: 10.21037/jss.2019.08.04] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background Full-endoscopic spine surgery (FESS) is a suitable treatment for lumbar disc herniation (LDH) and foraminal stenosis. This study investigated the usefulness of FESS in treating adjacent segment disease (ASD) after lumbar interbody fusion (LIF). Methods Between September 2015 and March 2019, a total of 13 patients with symptomatic ASD after LIF underwent FESS. Discectomy and foraminoplasty using a 3.5-mm diameter high-speed drill were performed for treating LDH and foraminal stenosis. Preoperative and postoperative statuses were evaluated using Numerical Rating Scale (NRS) and the modified Japanese Orthopedic Association (mJOA) scores. Results The patients' mean age was 64.8 years; there were 10 male and 3 female patients. The mean operative time was 52.7 min. The mean pre- and postoperative NRS scores were 7.6 and 3.1, respectively. The mean pre- and postoperative mJOA scores were 10.5 and 16.1, respectively, and the mean recovery rate was 32.8%. Subsequent operative treatments were required in 3 patients for postoperative complication, insufficient decompression, and recurrence LDH. Conclusions FESS is a safe and effective minimally invasive treatment for ASD after LIF and a potential alternative to extend the LIF to the adjacent vertebra or sacrum.
Collapse
Affiliation(s)
- Hiroki Iwai
- Iwai FESS Clinic, Tokyo, Japan.,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
| | - Tomoaki Kitagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, 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
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hirohiko Inanami
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| |
Collapse
|
16
|
Philips GAC, Oshima Y, Inoue H, Kitagawa T, Iwai H, Takano Y, Inanami H, Koga H. Full-endoscopic spine surgery for radiculopathy after osteoporotic vertebral compression fractures: a case report. JOURNAL OF SPINE SURGERY 2020; 6:466-471. [PMID: 32656384 DOI: 10.21037/jss.2019.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Full-endoscopic spine surgery (FESS) is a suitable treatment for lumbar disc herniation (LDH) and foraminal stenosis. Here, we describe the usefulness of FESS for treating radiculopathy after osteoporotic vertebral compression fractures (OVCFs). Between October 2018 and April 2019, three female patients (mean age, 81.7 years) with radiculopathy after OVCFs underwent FESS. Decompression of the corresponding nerve root was achieved using several FESS techniques, including foraminoplasty, discectomy, and removal of osteophyte or cement leakage. The mean operative time was 60.7 min. Preoperative and postoperative statuses were evaluated using numerical rating scale (NRS) scores. The mean pre- and postoperative NRS scores were 9 and 2.3, respectively. We observed no postoperative complications. Our results demonstrate that FESS is a safe and effective minimally invasive treatment for radiculopathy after OVCFs, with the potential to be an alternative to vertebroplasty, balloon kyphoplasty (BKP), or lumbar interbody fusion.
Collapse
Affiliation(s)
- Giby Abraham Cherry Philips
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedics and Spin, Al-Salaam International Hospital, Kuwait City, Kuwait
| | - Yasushi Oshima
- Department of Orthopaedics, Iwai Orthopaedic Medical 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, Jichi Medical University, Tochigi, Japan
| | - Tomoaki Kitagawa
- Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Iwai
- Iwai FESS Clinic, Tokyo, Japan.,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
| | - Hirohiko Inanami
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Iwai FESS Clinic, Tokyo, Japan.,Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| |
Collapse
|
17
|
Yan D, Zhang Z, Zhang Z. Residual leg numbness after endoscopic discectomy treatment of lumbar disc herniation. BMC Musculoskelet Disord 2020; 21:273. [PMID: 32340609 PMCID: PMC7187494 DOI: 10.1186/s12891-020-03302-5] [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: 02/24/2020] [Accepted: 04/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background Transforaminal endoscopic discectomy was popular in the treatment of lumbar disc herniation. Previous study focuses on the leg pain of disc herniation, and little study concern the residual leg numbness after surgery. The purposes of this study were to evaluate the clinical outcomes of transforaminal endoscopic discectomy in the treatment of lumbar disc herniation with leg pain and numbness. Methods Patients with one level lumbar disc herniation who had transforaminal endoscopic lumbar discectomy from June 2016 to July 2019 were categorized into two groups according to the leg numbness. 293 patients initially fulfilled the study criteria, and 27 patients were lost to follow-up. Of the remaining 266 patients available for analysis, 81 cases with leg numbness and pain (A group), and 185 cases with leg pain (B). Endoscopic transforaminal lumbar discectomy was performed, and the clinical outcomes of blood loss, operation times, hospital stay days, pain (Visual Analog Scale, VAS-pain), numbness (VAS-numbness), functional disability (Oswestry Disability Index, ODI), and the disk height and intervertebral foramen height were recorded. Results All patients with pain and numbness pre-operation in group A, complain of leg numbness during or just after walking or standing not diminished after surgery in group A, and no one complain numbness after surgery in group B. The pain index and ODI score were better than preoperational in all patients (P < 0.01), and no significant difference between two groups (P > 0.05). The postoperative disk and foramen height were no significant difference compare to preoperative in all patients (P > 0.05), and no significant difference between two groups (P > 0.05). The leg numbness symptoms last longer in central disc herniation patients (10.4 ± 2.2 months) than in paracentral (6.3 ± 2.1 months) and foraminal disc herniation patients (5.6 ± 2.3 months) after surgery (P < 0.01). Conclusions Based on the results of this study, transforaminal endoscopic lumbar discectomy was effective and safe procedures in the treatment of disc herniation with leg pain and numbness. The leg numbness symptoms last longer in central disc herniation patients than in paracentral and foraminal disc herniation patients after surgery.
Collapse
Affiliation(s)
- Denglu Yan
- Orthopedics department, First People's Hospital of Zhaoqing, Zhaoqing City, Guangdong Province, 526000, People's Republic of China.
| | - Zaiheng Zhang
- Orthopedics department, People's Hospital of Baoan, Shenzhen City, Guangdong Province, 518101, People's Republic of China
| | - Zhi Zhang
- Orthopedics department, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou City, Guangdong Province, 510150, People's Republic of China
| |
Collapse
|
18
|
Zhang B, Zhou F, Wang L, Wang H, Jiang J, Guo Q, Lu X. A new decompression technique for upper lumbar fracture with neurologic deficit-comparison with traditional open posterior surgery. BMC Musculoskelet Disord 2019; 20:580. [PMID: 31787080 PMCID: PMC6886208 DOI: 10.1186/s12891-019-2897-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 10/14/2019] [Indexed: 12/25/2022] Open
Abstract
Background Surgery is usually recommended for thoracolumbar fracture with neurologic deficit. However, traditional open posterior approach requires massive paraspinal muscles stripping, and the canal decompression may be limited and incomplete. We aimed to investigate a new approach via the Wiltse approach and the Kambin’s Triangle. Methods Twenty-one consecutive patients with traumatic upper lumbar fracture who received this new approach surgery between January 2015 and January 2016 constituted the new approach group. Twenty-nine patients received the traditional open posterior surgery between January 2014 and January 2015 were classified as the traditional posterior surgery group. Surgical informations including operative time, blood loss, drainage volume, hospitalization days were collected and compared among the two groups. The American Spinal Injury Association (ASIA) impairment scale and Visual Analog Score (VAS) were evaluated preoperatively, postoperatively and at 12 months follow-up. Results Patients in the new approach group had fewer operation time (128.3 ± 25.1 vs 151 ± 32.2 min, P = 0.01), less blood loss (243.8 ± 135.5 vs 437.8 ± 224.9 ml, P = 0.001) and drainage volume (70.7 ± 57.2 vs 271.7 ± 95.5 ml, P < 0.001), as well as shorter hospitalization stay than the traditional posterior surgery group (6.6 ± 1.8 vs 8.5 ± 2.4 d, P = 0.004). Similar neurologic recovery according to ASIA grade was achieved in both groups (Recovery index: 0.90 ± 0.53 vs 0.86 ± 0.51, P = 0.778). While the pain level was significantly lower in the new approach group postoperatively (2.6 ± 0.7 vs 3.5 ± 0.9, P < 0.001) and at 12 months follow-up (1.4 ± 0.9 vs 2.4 ± 0.8, P < 0.001). Conclusion The present new approach was successfully applied in the treatment of upper lumbar fracture with neurologic deficit. It can reduce iatrogenic trauma and achieve similar or better outcomes compared to the traditional posterior surgery.
Collapse
Affiliation(s)
- Bangke Zhang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Fengjin Zhou
- Department of Spinal Surgery, Xi'an Zhongde Orthopedics Hospital, Xi'an, China
| | - Liang Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Haibin Wang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jiayao Jiang
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Qunfeng Guo
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Xuhua Lu
- Department of Orthopaedics, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, China.
| |
Collapse
|
19
|
Hu D, Fei J, Chen G, Yu Y, Lai Z. Treatment for lumbar spinal stenosis in elderly patients using percutaneous endoscopic lumbar discectomy combined with postoperative three-dimensional traction. Expert Rev Med Devices 2019; 16:317-323. [PMID: 30916589 DOI: 10.1080/17434440.2019.1599282] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Dexin Hu
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Jun Fei
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Genjun Chen
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Yongjie Yu
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| | - Zhen Lai
- Department of orthopedics, Hangzhou Red Cross Hospital, Hangzhou, Zhejiang, China
| |
Collapse
|
20
|
Fujita M, Kawano H, Kitagawa T, Iwai H, Takano Y, Inanami H, Koga H. Preoperative Design for the Posterolateral Approach in Full-Endoscopic Spine Surgery for the Treatment of L5/S1 Lumbar Disc Herniation. Neurospine 2019; 16:105-112. [PMID: 30943712 PMCID: PMC6449817 DOI: 10.14245/ns.1836316.158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/04/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Full-endoscopic spine surgery (FESS) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the optimal operative route of the posterolateral approach (PLA) of FESS for the treatment of L5/S1 LDH. METHODS Between June 2016 and November 2018, a total of 21 patients with leg pain due to L5/S1 LDH underwent PLA of FESS. According to the partial removal of the superior articular process (SAP) of the L5/S1 facet joint (FJ), we categorized these patients into 2 groups. LDH type, anatomical configurations (FJ, sacral ala [SA], and iliac crest [IC]), the presence or absence of spondylolysis, operation time, and operative outcome were compared between these 2 groups. RESULTS Although the anatomical configuration of the FJ was the most important factor for the necessity of SAP removal, the configuration of the SA and IC did not restrict endoscope insertion and subsequent LDH removal. Even in intracanal LDH, the removal of SAP was not absolutely required depending on the FJ configuration. Furthermore, the presence of spondylolysis was a factor associated with the unnecessity of SAP removal. CONCLUSION Detailed radiological examination of the FJ configuration is an important preoperative investigation to determine the optimal operative route for PLA of FESS.
Collapse
Affiliation(s)
- Muneyoshi Fujita
- Iwai FESS clinic, Tokyo, Japan.,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- Iwai FESS clinic, Tokyo, Japan.,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomoaki Kitagawa
- Iwai FESS clinic, Tokyo, Japan.,Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hiroki Iwai
- Iwai FESS clinic, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | | | - Hirohiko Inanami
- Iwai FESS clinic, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| | - Hisashi Koga
- Iwai FESS clinic, Tokyo, Japan.,Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, Tokyo, Japan
| |
Collapse
|
21
|
Working Cannula-Based Endoscopic Foraminoplasty: A Technical Note. BIOMED RESEARCH INTERNATIONAL 2018; 2018:4749560. [PMID: 30671454 PMCID: PMC6323537 DOI: 10.1155/2018/4749560] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 11/21/2018] [Indexed: 12/17/2022]
Abstract
Purpose Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive disc surgery that can be performed under local anesthesia and requires only an eight-mm skin incision. For the patients with lumbar foraminal stenosis, the migrated disc is difficult to remove with a simple transforaminal approach. In such cases, the foraminoplasty techniques can be used. However, obtaining efficient foramen enlargement while minimizing radiation exposure and protecting the nerves can be challenging. Methods In this study, we propose a new technique called the Kiss-Hug maneuver. Under endoscopic viewing, we used the bevel tip of a working cannula as a bone reamer to enlarge the foramen. This allowed us to efficiently enlarge the lumbar foramen endoscopically without the redundancy and complications associated with reamers or trephines. Results Details of the four steps of the Kiss-Hug maneuver are reported along with adverse events. The advantages of this new technique include minimizing radiation exposure to both the surgeon and the patient and decreasing the overall operation time. Conclusion The endoscopic Kiss-Hug maneuver is a useful and reliable foraminoplasty technique that can enhance the efficiency of foraminoplasty while ensuring patient safety and reducing radiation exposure.
Collapse
|
22
|
Ishibashi K, Oshima Y, Inoue H, Takano Y, Iwai H, Inanami H, Koga H. A less invasive surgery using a full-endoscopic system for L5 nerve root compression caused by lumbar foraminal stenosis. JOURNAL OF SPINE SURGERY 2018; 4:594-601. [PMID: 30547124 DOI: 10.21037/jss.2018.06.18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Percutaneous endoscopic lumbar discectomy (PELD) is a relatively less invasive treatment for lumbar disc herniation (LDH). This study investigated the usefulness of a full-endoscopic system for PELD to treat L5 nerve root compression caused by lumbar foraminal stenosis (L5-LFS). Methods Between November 2016 and December 2017, a total of 10 patients with unilateral leg pain due to L5-LFS underwent surgery using a full-endoscopic system for PELD. Patients with bilateral L5-LFS or L5-LFS with coexisting LDH and/or spondylolysis were excluded from this study. A percutaneous endoscopic translaminar approach (PETA) was performed via the ipsilateral vertebral isthmus using a 3.5-mm diameter high-speed drill. Preoperative and postoperative statuses were evaluated using the modified Japanese Orthopedic Association (mJOA) and Numerical Rating Scale (NRS) scores. Results The patients' mean age was 62.2 years; there were 7 male and 3 female patients. The mean recovery rate was 58.2% with the mJOA score; mean pre- and postoperative NRS scores were 7.4 and 2.3, respectively. The mean operative time was 77.6 min. Although there were no major complications, pain did not improve in an 80-year-old woman with coexisting spondylolisthesis (Meyerding grade 2). Conclusions PETA using a full-endoscopic system is a safe and effective minimally invasive treatment for L5-LFS, with potential to be an alternative surgical strategy for L5-S1 interbody fusion.
Collapse
Affiliation(s)
- Katsuhiko Ishibashi
- 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
| | - Hiroki Iwai
- 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
| |
Collapse
|
23
|
Zhang Y, Pan Z, Yu Y, Zhang D, Ha Y, Yi S, Shin DA, Sun J, Koga H, Phan K, Azimi P, Huang W, Cao K. The modified transforaminal endoscopic technique in treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniations. Quant Imaging Med Surg 2018; 8:936-945. [PMID: 30505722 DOI: 10.21037/qims.2018.10.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background To develop a modified transforaminal endoscopic spine system (TESSYS®) technique for treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniation (ICFE-LDH), and evaluate the technical efficacy and safety. Methods Twenty-three patients with ICFE-LDH underwent the modified TESSYS technique were enrolled. Magnetic resonance imaging (MRI) was used to verify the reduction of herniated disc. Pre- and post-operative neurological functions were compared by visual analogue scale (VAS) score, Oswestry disability index (ODI) and the modified MacNab criteria. The technical safety was evaluated by surgical complications. Results MRI demonstrated reductions of disc herniations in 22 patients (95.7%) after surgeries. The VAS scores were significantly improved at 1 year follow-up (low back: P=0.001, lower limbs: P<0.001), as well as ODI scores (P<0.001). 22 patients had achieved excellent and good recovery postoperatively according to the modified MacNab criteria. One patient (4.3%) underwent a reoperation due to postoperative recurrence of disc herniation. Another patient complained postoperative causalgia in 8 weeks, the symptom alleviated after conservative treatment at 1 year follow-up (VAS: back, 3, lower limbs, 0; ODI: 20%). The incidence rate of surgical complication was 8.7%. Conclusions The modified TESSYS technique is a minimally-invasive, effective and safe surgery for treating ICFE-LDHs in selected patients.
Collapse
Affiliation(s)
- Yong Zhang
- Pain Department, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Zhimin Pan
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Yanghong Yu
- Department of Radiology, Jiangxi Province Children's Hospital, Nanchang 330006, China
| | - Daying Zhang
- Pain Department, the First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul 03722, Republic of Korea
| | - Jingyi Sun
- Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Gangwon 220-701, Republic of Korea
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, Tokyo, Japan
| | - Kevin Phan
- NeuroSpine Surgery Research Group (NSURG); Prince of Wales Clinical School, University of New South Wales, Randwick, Sydney, Australia
| | - Parisa Azimi
- Functional Neurosurgery Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Wei Huang
- Department of Clinical Laboratory, Jiangxi Province Children's Hospital, Nanchang 330006, China
| | - Kai Cao
- Department of Orthopedics, the Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | | |
Collapse
|
24
|
Endoscopic lumbar discectomy and minimally invasive lumbar interbody fusion: a contrastive review. Wideochir Inne Tech Maloinwazyjne 2018; 13:429-434. [PMID: 30524611 PMCID: PMC6280080 DOI: 10.5114/wiitm.2018.77744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Accepted: 07/11/2018] [Indexed: 12/27/2022] Open
Abstract
Both percutaneous endoscopic lumbar discectomy (PELD) and minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) have been demonstrated as two common and effective choices for lumbar disc herniation (LDH) minimally invasive surgery. In order to get a better understanding of these two procedures, we made this contrastive review. By looking up recent literature and combining it with our clinical practice, the indications/contraindications, advantages/disadvantages as well as complications/recurrences of PELD and MIS-TLIF were summarized in this review. It was concluded that PELD and MIS-TLIF are safe and effective minimally invasive operative techniques for symptomatic LDH treatment. A better understanding of these two procedures will help to improve clinical outcomes by selecting proper indications, and also benefit the further development of minimally invasive spine surgery.
Collapse
|
25
|
Choy WJ, Phan K, Diwan AD, Ong CS, Mobbs RJ. Annular closure device for disc herniation: meta-analysis of clinical outcome and complications. BMC Musculoskelet Disord 2018; 19:290. [PMID: 30115053 PMCID: PMC6097319 DOI: 10.1186/s12891-018-2213-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 07/31/2018] [Indexed: 12/13/2022] Open
Abstract
Background Lumbar intervertebral disc herniation is a common cause of lower back and leg pain, with surgical intervention (e.g. discectomy to remove the herniated disc) recommended after an appropriate period of conservative management, however the existing or increased breach of the annulus fibrosus persists with the potential of reherniation. Several prosthesis and techniques to reduce re-herniation have been proposed including implantation of an annular closure device (ACD) – Barricaid™ and an annular tissue repair system (AR) – Anulex-Xclose™. The aim of this meta-analysis is to assist surgeons determine a potential approach to reduce incidences of recurrent lumbar disc herniation and assess the current devices regarding their outcomes and complications. Methods Four electronic full-text databases were systematically searched through September 2017. Data including outcomes of annular closure device/annular repair were extracted. All results were pooled utilising meta-analysis with weighted mean difference and odds ratio as summary statistics. Results Four studies met inclusion criteria. Three studies reported the use of Barricaid (ACD) while one study reported the use of Anulex (AR). A total of 24 symptomatic reherniation were reported among 811 discectomies with ACD/AR as compared to 51 out of 645 in the control group (OR: 0.34; 95% CI: 0.20,0.56; I2 = 0%; P < 0.0001). Durotomies were lower among the ACD/AR patients with only 3 reported cases compared to 7 in the control group (OR: 0.54; 95% CI: 0.13, 2.23; I2 = 11%; P = 0.39). Similar outcomes for post-operative Oswestry Disability Index and visual analogue scale were obtained when both groups were compared. Conclusion Early results showed the use of Barricaid and Anulex devices are beneficial for short term outcomes demonstrating reduction in symptomatic disc reherniation with low post-operative complication rates. Long-term studies are required to further investigate the efficacy of such devices.
Collapse
Affiliation(s)
- Wen Jie Choy
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia
| | - Kevin Phan
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia.,NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia.,Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia
| | - Ashish D Diwan
- Spine Service, Department of Orthopaedic Surgery, St. George & Sutherland Clinical School, University of New South Wales, Kogarah, 2217, New South Wales, Australia
| | - Chon Sum Ong
- Newcastle University Medicine Malaysia (NUMed), Johor, Malaysia
| | - Ralph J Mobbs
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia. .,NeuroSpine Surgery Research Group (NSURG), Prince of Wales Private Hospital, Sydney, Australia. .,Department of Neurosurgery, Prince of Wales Private Hospital, Sydney, Australia.
| |
Collapse
|
26
|
Yokosuka J, Oshima Y, Kaneko T, Takano Y, Inanami H, Koga H. Advantages and disadvantages of posterolateral approach for percutaneous endoscopic lumbar discectomy. JOURNAL OF SPINE SURGERY 2016; 2:158-166. [PMID: 27757427 DOI: 10.21037/jss.2016.09.03] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) is one of the less invasive treatments for lumbar disc herniation (LDH), and has 3 different operative approaches. This study focused on the posterolateral approach (PLA) and investigated the appropriate operative indication. METHODS PLA was performed in 29 patients with foraminal and extraforaminal LDH. The height and width of the foramen, LDH type, and positional relationship between LDH and the foramen were radiologically evaluated. Foraminoplasty was also performed in 12 cases including those combined with intra-canal LDH or osseous foraminal stenosis. Pre- and postoperative status was evaluated using Numerical Rating Scale (NRS) scores. RESULTS Patient mean age was 56.8 years; there was single-level involvement at L3/4 (13 cases) and at L4/5 (13 cases). The mean pre- and postoperative NRS scores were 6.1 and 1.8, respectively. Early recurrence developed in a patient who was found to have local scoliosis at the corresponding vertebral level. CONCLUSIONS PLA can be safely used to treat foraminal and extraforaminal LDH with foraminal height ≥13 mm and foraminal width ≥7 mm. The procedure is effective for preserving the facet joint; however, we should carefully consider the indications when local scoliosis and/or instability are present.
Collapse
Affiliation(s)
- Junichi Yokosuka
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Yasushi Oshima
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan; ; Department of Orthopaedic Surgery, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku Tokyo 113-8655, Japan
| | - Takeshi Kaneko
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Yuichi Takano
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Hirohiko Inanami
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| | - Hisashi Koga
- Department of Orthopaedics, Iwai Orthopaedic Medical Hospital, 8-17-2 Minamikoiwa Edogawa-ku, Tokyo 133-0056, Japan; ; Department of Orthopaedic Surgery, Inanami Spine and Joint Hospital, 3-17-5 Higashishinagawa Shinagawa-ku, Tokyo 140-0002, Japan
| |
Collapse
|