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Kapetanakis S, Gkantsinikoudis N. Transforaminal lumbar endoscopic discectomy: should we abandon it for L5-S1 foraminal and extraforaminal lumbar disc herniations? A prospective non-randomised study and literature review. Br J Neurosurg 2024:1-8. [PMID: 39139077 DOI: 10.1080/02688697.2024.2389839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/24/2024] [Accepted: 08/04/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE The aim of this study is to investigate the clinical outcomes of transforaminal lumbar endoscopic discectomy (TLED) in patients with L5-S1 lumbar disc herniation (LDH). MATERIALS AND METHODS Seventy-five consecutive individuals with diagnosed foraminal/extraforaminal L5-S1 LDH were included in this study. All patients underwent TLED, being subsequently evaluated in a 2-year follow-up period. Assessment was performed preoperatively and at 6 weeks and 3, 6, 12 and 24 months postoperatively. Visual Analogue Scale (distinctly applied for lower limb - VAS-LP and low back - VAS-BP pain) and Short-Form 36 (SF-36) Medical Health Survey Questionnaire were implemented to assess pain and health-related quality of life (HRQoL) of enrolled individuals, respectively. RESULTS No major perioperative complications were observed. Recorded values of all studied indices were demonstrated to feature a clinically and statistically significant amelioration at 6 weeks, presenting lesser improvement at 3 months with subsequent stabilisation. VAS-LP and VAS-BP values were displayed to reach a plateau in 6 months postoperatively, whereas all parameters of SF-36 continued to present a statistically significant improvement until the end of follow-up at 2 years. CONCLUSIONS TLED represent a safe and efficient technique in terms of diminishing perceived pain and improving HRQoL in patients with L5-S1 LDHs. However, specific patient- and technique-related circumstances on the ground of low surgical experience may limit its effectiveness in these patients.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
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Kapetanakis S, Floros E, Gkantsinikoudis N. Extreme cases in percutaneous transforaminal endoscopic surgery: case series and brief review of the literature. Br J Neurosurg 2024; 38:94-98. [PMID: 34187254 DOI: 10.1080/02688697.2021.1944981] [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: 02/08/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Percutaneous transforaminal endoscopic decompression (PTED) is a minimally invasive method of surgical treatment of miscellaneous spinal conditions. We describe our experience with PTED in extreme cases of foraminal stenosis (FS) in adult degenerative scoliosis (ADS), recurrent foraminal stenosis (RFS) after previous open decompression surgery and adjacent segment disease (ASD) after previous lumbar fusion. METHODS Twenty-one (21) patients with FS encountered in the clinical framework of ADS (n = 6), previous open decompression surgery (n = 8) and ASD (n = 7) were prospectively reviewed. Patients were preoperatively assessed via clinical and radiologic evaluation. All patients underwent PTED in 2018-2019. Postoperative evaluation was conducted with clinical examination and evaluation of Visual Analogue Scale (VAS), Oswestry Disability Index (ODI) and modified MacNab criteria in predetermined chronic intervals in a 1-2 years follow-up. RESULTS All patients were successfully managed with PTED. Operated levels were L3-L4 (19.0%), L4-L5 (52.4%) and L5-S1 (28.6%). No major perioperative complications were recorded. VAS and ODI scores were demonstrated to exhibit a clinically and statistically significant (p < 0.05) amelioration in all patients' categories directly postoperatively, which was preserved until the end of follow-up. Overall outcomes according to modified MacNab criteria were excellent in 12 patients (57.1%), good in 6 (28.6%) and fair in 3 (14.3%) patients. CONCLUSIONS PTED is safe and effective in extreme cases of FS encountered in patients with ADS, previous posterior open decompression surgery and ASD after previous spinal fusion.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
- Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | - Evangelos Floros
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Kapetanakis S, Gkantsinikoudis N, Apostolakis S. Technical challenges and surgical outcomes of percutaneous transforaminal endoscopic discectomy in patients with upper lumbar disc herniation: a prospective clinical study. Arch Orthop Trauma Surg 2022:10.1007/s00402-022-04725-6. [PMID: 36543922 DOI: 10.1007/s00402-022-04725-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Upper lumbar disc herniation (ULDH) constitutes a considerably complex and rare anatomic entity. As such, there are only a handful of studies investigating the application of percutaneous transforaminal endoscopic discectomy (PTED) in the management of this cause of low back pain. RESEARCH QUESTION To elucidate the safety and effectiveness of PTED in patients with ULDH. MATERIALS AND METHODS Twenty-six (26) individuals with diagnosed ULDH (L1-L2, L2-L3) according to clinical and radiologic criteria were prospectively evaluated in a 2-year follow-up period. All patients were assessed preoperatively and at 6 weeks and 3, 6, 12, and 24 months postoperatively. Clinical evaluation was conducted with visual analogue scale for lower limb (VAS-LP) and low back (VAS-BP) pain in conjunction with Short-Form 36 (SF-36) Medical Health Survey Questionnaire. Potential complications were recorded in each follow-up interval. RESULTS One patient (3.8%) featured temporary postoperative dysesthesia that was completely resolved at 6 weeks. No other major perioperative complications were observed. Values of all studied indices were found to be statistically significantly ameliorated at the end of follow-up. Improvement was depicted to be quantitatively maximal at 6 weeks postoperatively. CONCLUSIONS PTED constitutes a safe and effective technique for surgical management of ULDH that merits further assessment in current clinical practice in the framework of multicenter randomized controlled trials. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece. .,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, 15125, Athens, Greece.
| | - Nikolaos Gkantsinikoudis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece
| | - Sotirios Apostolakis
- Spine Department and Deformities, Interbalkan European Medical Center, 55535, Thessaloniki, Greece
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Patgaonkar P, Goyal V, Agrawal U, Marathe N, Patel V. Impact of Body Weight, Height, and Obesity on Selection of Skin Entry Point for Transforaminal Endoscopic Lumbar Discectomy. Asian J Neurosurg 2022; 17:262-267. [PMID: 36120643 PMCID: PMC9473811 DOI: 10.1055/s-0042-1751005] [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] [Indexed: 11/02/2022] Open
Abstract
Background Prospective evaluation of the effect of physical parameters like height, weight and abdominal girth on different skin entry points in transforaminal endoscopic lumbar discectomy (TELD) in lower lumbar discs.
Methods This prospective study involved 174 patients with unilateral radicular pain or discogenic back pain, central, paracentral disc herniations and lateral canal stenosis at the level from L3 to S1 radiologically confirmed by magnetic resonance imaging (MRI) and failed conservative trial for 6 weeks. All patients underwent measurements of height, weight, body mass index (BMI), and abdominal girth preoperatively. All the four possible entry points, i.e., 45 to 45, posterolateral (PL), tip of spinous process (TOSP), and dorsum of the facet joint, were marked and point midway between PL and TOSP (PL-TOSP) skin entry was used.
Results The change in the value, i.e., distance from midline of all the entry points with physical parameters like height, weight, BMI, and abdominal circumference was statistically significant. The visual analog scale score decreased from a preoperative value of 7.98 to 1.84 at 6 months follow-up. The Oswestry disability index score improved from 72.53 to 16.26.
Conclusion The entry point in TELD is not a fixed value as it varies with the physical parameters like weight and abdominal girth of the patient. PL-TOSP is a safe entry point for common pathologies like central, paracentral herniations and lateral canal stenosis in lower lumbar levels and can be predicted preoperatively by proposed formula.
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Affiliation(s)
- Prasad Patgaonkar
- Department of Orthopaedic-Spine, Indore Spine Centre, Indore, Madhya Pradesh, India
| | - Vaibhav Goyal
- Department of Orthopaedic-Spine, Indore Spine Centre, Indore, Madhya Pradesh, India
| | - Utkarsh Agrawal
- Department of Orthopaedic-Spine, Indore Spine Centre, Indore, Madhya Pradesh, India
| | - Nandan Marathe
- Department of Orthopaedic-Spine, Indore Spine Centre, Indore, Madhya Pradesh, India
| | - Vivek Patel
- Department of Orthopaedic-Spine, Indore Spine Centre, Indore, Madhya Pradesh, India
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. Implementation of Percutaneous Transforaminal Endoscopic Discectomy in Competitive Elite Athletes With Lumbar Disc Herniation: Original Study and Review of the Literature. Am J Sports Med 2021; 49:3234-3241. [PMID: 34491150 DOI: 10.1177/03635465211032612] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Lumbar disc herniation (LDH) represents a frequent clinical entity in athletes. Surgical treatment of LDH with endoscopic spine surgical techniques has been proposed as a feasible alternative in these patients. PURPOSE To study the particular outcomes of percutaneous transforaminal endoscopic discectomy (PTED) in competitive elite athletes with surgically treatable LDH. STUDY DESIGN Case series; Level of evidence, 4. METHODS A total of 55 competitive elite athletes with diagnosed LDH based on clinical and radiologic criteria were enrolled in this prospectively designed study. All patients underwent successful PTED. Clinical evaluation was conducted with the well-established visual analog scale for lower limb and low back pain separately. The 36-Item Short Form Health Survey (SF-36) was implemented for health-related quality of life analysis. Patients were assessed preoperatively and at regular postoperative intervals: 6 weeks and 3, 6, and 12 months, as well as 2 years. RESULTS Operated levels were L3-L4 (5.5%), L4-L5 (69.1%), and L5-S1 (25.4%). No major perioperative complications were observed. All patients successfully reached the end of follow-up at 2 years. Both visual analog scale scores (lower limb and low back pain) showed clinically and statistically significant improvement at 6 weeks postoperatively, with subsequent minor improvement and stabilization. All recorded SF-36 parameters demonstrated major clinical amelioration at 6 weeks, with subsequent minor but constant statistically significant improvement until the end of follow-up. Comparative evaluation of the SF-36 revealed that the physical function, bodily pain, role-emotional, and mental health parameters showed quantitatively greater improvement in comparison with rest indices. CONCLUSION PTED constitutes a feasible and effective technique for surgical management of LDH in athletes, providing favorable outcomes in terms of postoperative pain and health-related quality of life. Proper performance of technique for specific cases of L5-S1 LDH may be more challenging, and these cases should be evaluated selectively for suitability for this procedure.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.,Department of Minimally Invasive and Endoscopic Spine Surgery, Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Shi Z, Shi L, Chen X, Liu J, Wu H, Wang C, Chen Z, Yang F, Yu S, Pang Q. The biomechanical effect on the adjacent L4/L5 segment of S1 superior facet arthroplasty: a finite element analysis for the male spine. J Orthop Surg Res 2021; 16:391. [PMID: 34140040 PMCID: PMC8212469 DOI: 10.1186/s13018-021-02540-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background The superior facet arthroplasty is important for intervertebral foramen microscopy. To our knowledge, there is no study about the postoperative biomechanics of adjacent L4/L5 segments after different methods of S1 superior facet arthroplasty. To evaluate the effect of S1 superior facet arthroplasty on lumbar range of motion and disc stress of adjacent segment (L4/L5) under the intervertebral foraminoplasty. Methods Eight finite element models (FEMs) of lumbosacral vertebrae (L4/S) had been established and validated. The S1 superior facet arthroplasty was simulated with different methods. Then, the models were imported into Nastran software after optimization; 500 N preload was imposed on the L4 superior endplate, and 10 N⋅m was given to simulate flexion, extension, lateral flexion and rotation. The range of motion (ROM) and intervertebral disc stress of the L4-L5 spine were recorded. Results The ROM and disc stress of L4/L5 increased with the increasing of the proportions of S1 superior facet arthroplasty. Compared with the normal model, the ROM of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 2/5 from the apex to the base. The disc stress of L4/L5 significantly increased in most directions of motion when S1 superior facet formed greater than 3/5 from the ventral to the dorsal or 1/5 from the apex to the base. Conclusion In this study, the ROM and disc stress of L4/L5 were affected by the unilateral S1 superior facet arthroplasty. It is suggested that the forming range from the ventral to the dorsal should be less than 3/5 of the S1 upper facet joint. It is not recommended to form from apex to base. Level of evidence Level IV
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Affiliation(s)
- Zewen Shi
- Ningbo University School of Medicine, Ningbo, China
| | - Lin Shi
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Xianjun Chen
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Jiangtao Liu
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Haihao Wu
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Chenghao Wang
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China
| | - Zeming Chen
- Ningbo University School of Medicine, Ningbo, China
| | - Fang Yang
- Ningbo University School of Medicine, Ningbo, China
| | - Sheng Yu
- Ningbo University School of Medicine, Ningbo, China
| | - Qingjiang Pang
- Department of Orthopaedics, Hwa Mei Hospital, The Affiliated Hospital of University of Chinese Academy of Science, Ningbo, 315010, China.
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Kumari C, Gupta T, Gupta R, Kumar V, Sahni D, Aggarwal A, Neelkamal. Cadaveric anatomy of the lumbar triangular safe zone of Kambin's in North West Indian population. Anat Cell Biol 2021; 54:35-41. [PMID: 33619238 PMCID: PMC8017462 DOI: 10.5115/acb.20.243] [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: 09/16/2020] [Revised: 12/01/2020] [Accepted: 12/07/2020] [Indexed: 11/27/2022] Open
Abstract
A three dimensional triangular space ‘the Kambin’s triangle (KT)’ present on the dorsolateral aspect of the intervertebral disc, is considered to be a safe area for transforaminal approaches. It allows access to the exiting and traversing nerve roots, the thecal sac and to the intervertebral disc spaces. Our aim was to calculate the area of the triangle by measuring the height and base at all the intervertebral spaces bilaterally in the lumbar region in North West Indian cadavers and to assess the diameter of circle inscribed within this triangle which will correspond to the size of cannula inserted for the minimally invasive transforaminal approaches in this population. Five randomly chosen adult cadavers were used for this study. After clearing the area, the exiting nerve was identified. The height and base of the bony KTs (n=40) were measured with the help of digital Vernier’s calliper (accuracy 0.02 mm) to calculate the area of the KT. There is a steady increase in the area of the bony KT reaching maximum at the level of L4-5 intervertebral space. Statistically there were no differences in the calculated areas between right and left side. The mean diameter of inscribed circle within the triangle also showed gradual increase from 5.82 mm at L1-2 level, reaching maximum value of 7.26 mm at L4-5 level on the right side while on the left side the values were 5.66 mm and 8.16 mm respectively. Careful anatomical consideration is of utmost importance in transforaminal approaches during surgical or interventional procedures in this region. Cannula having external diameter ranging 6–8 mm is recommended for any interventional approach through Kambin’s space.
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Affiliation(s)
- Chiman Kumari
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Richa Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vishal Kumar
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelkamal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Yu Y, Zhou Q, Xie YZ, Wang XL, Fan XH, Gu DW, Huang X, Wu WD. Effect of Percutaneous Endoscopic Lumbar Foraminoplasty of Different Facet Joint Portions on Lumbar Biomechanics: A Finite Element Analysis. Orthop Surg 2020; 12:1277-1284. [PMID: 32643308 PMCID: PMC7454218 DOI: 10.1111/os.12740] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 05/13/2020] [Accepted: 06/03/2020] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the influence of percutaneous endoscopic lumbar foraminoplasty of different facet joint portions on segmental range of motion (ROM) and intradiscal pressure (IDP) of L3/L4 and L4/L5 motion segments by establishing three dimensional finite element (FE) model. Method Computed tomography images of a male adult volunteer of appropriate age and in good condition both mentally and physically. Obtained data was used in this study from July 2020 to December 2020, and an intact L3–5 three dimensional finite element model was successfully constructed using ANSYS and MIMICS software (model M1). The M1 was modified to simulate the foraminoplasty of different facet joint portions, with unilateral cylindrical excision (diameter = 0.75 cm) performed on the tip (model M2) and the base (model M3) of right L5 superior facet elements along with surrounding capsular ligaments, respectively. Under the same loading conditions, the ROM and IDP of L3/4 and L4/L5 segments in states of forward flexion, backward extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation were all compared. Result Compared with the intact model in backward extension, M2 increased the ROM of L4/5 segment by 9.4% and IDP by 11.7%, while the ROM and IDP of M3 changed only slightly. In right axial rotation, M2 and M3 increased the ROM of L4/5 segment by 17.9% and by 3.6%, respectively. In left axial rotation, M2 and M3 increased the ROM of L4/L5 segment by 7.14% and 3.6%, respectively. As for other states including forward flexion, left lateral bending, right lateral bending, the ROM and IDP were not significantly distinct between these two models. While focusing on L3/L4 segment, obviously changes in the ROM and IDP have not been presented and neither M2 nor M3 changed in any loading condition. Conclusion This study provides evidence that the base‐facet foraminoplasty of L5 superior facet provided a higher segmental stability compared with the tip‐facet foraminoplasty in flexion and axial rotation. Meanwhile, it also shows the two types of foraminoplasty make few differences to the L4/5 segmental biomechanics. Besides, it does not appear to impact the stability of L3/L4 in six states of forward flexion, backward extension, left lateral bending, right lateral bending, left axial rotation and right axial rotation when superior facet of L5 was partially removed. These findings might be useful in understanding biomechanics of the lumbar spine after foraminoplasty performed on different portions of the facet, thus providing endoscopic surgeons a better reference for operational approach to maintain the function and mobility of the spine.
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Affiliation(s)
- Yang Yu
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qun Zhou
- Institution of Nurseury, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi-Zhou Xie
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin-Ling Wang
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao-Hong Fan
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dang-Wei Gu
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xue Huang
- Department of Orthopaedic, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Wei-Dong Wu
- Institution of Nurseury, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Biomechanics Laboratory, Southern Medical University, Guangzhou, China
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Xu Z, Zheng JC, Sun B, Zhang K, Wang YH, Shi CG, Wu HQ, Wu XD, Chen HJ, Yuan W. Bi-needle technique versus transforaminal endoscopic spine system technique for percutaneous endoscopic lumbar discectomy in treating intervertebral disc calcification: a propensity score matched cohort analysis. Br J Neurosurg 2020; 35:245-250. [PMID: 32633573 DOI: 10.1080/02688697.2020.1784393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the clinical results of a Bi-needle technique and conventional transforaminal endoscopic spine system (TESSYS) technique for percutaneous endoscopic lumbar discectomy (PELD) in treating patients with intervertebral disc calcification (IDC). BACKGROUND PELD has gained acceptance for treating patients with IDC. The Bi-needle technique was designed to improve the efficiency and safety of PELD. METHOD Bi-needle and TESSYS group within each cohort were balanced using 1:1 propensity score matching. Finally, 32 patients with IDC treated by Bi-needle technique from December 2015 to September 2017 were enrolled and 25 patients treated by TESSYS technique from the same spine surgery center between January 2013 and October 2017 were enrolled as controls. RESULTS Propensity score matching generated 22 Bi-needle and 22 TESSYS patients. There were no significant differences in visual analog scale and lumbar Japanese Orthopaedic Association scores between Bi-needle and TESSYS group. Operative time and rate of complications in the Bi-needle was significantly better than the TESSYS group (p < 0.01). CONCLUSIONS Both surgical methods achieved good clinical outcomes. However, compared with the TESSSY technique, operative time of the Bi-needle technique is shorter, and rate of complications is lower.
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Affiliation(s)
- Zeng Xu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Jian-Cheng Zheng
- Department of Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bin Sun
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ke Zhang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yun-Hao Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Chang-Gui Shi
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hui-Qiao Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xiao-Dong Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hua-Jiang Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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Xie Y, Zhou Q, Wang X, Jian Q, Fan X, Yu Y, Gu D, Wu W. The biomechanical effects of foraminoplasty of different areas under lumbar percutaneous endoscopy on intervertebral discs: A 3D finite element analysis. Medicine (Baltimore) 2020; 99:e19847. [PMID: 32332639 PMCID: PMC7220751 DOI: 10.1097/md.0000000000019847] [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] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND We set out to evaluate the biomechanical influence of foraminoplasty on intervertebral discs in different areas under lumber percutaneous endoscopy through the use of a three-dimensional finite element. METHODS We established a normal 3D finite element mode of L3-5, using simulate lumbar percutaneous endoscopy by carrying out cylindrical excision of a bone whose diameter was 7.5 mm on the L5 superior articular process and the L4 inferior articular process, respectively. We therefore obtained 3 models. The first was the normal lumbar model, the second the L4 inferior articular process shaped model, while the third was the L5 superior articular process shaped model. We compared the biomechanics of discs of L3/4 and L4/5 in states of forward flexion, backward extension, left and right flexion as well as left and right rotation. RESULTS When the L4 inferior articular process shaped model was in backward extension, left rotation, and right rotation, the stress of the L4/5 disc was greater than in the normal model, especially in the state of extension. When the L5 superior articular process shaped model was in left and right rotation, the biggest stress of the L4/5 disc increased slightly. However, no matter which way the L5 superior articular process or the L4 inferior articular process of model was shaped, the stress impact of the L3/4 disc was small. CONCLUSIONS There is more biomechanical influence on the L4/5 disc when carrying out a foraminoplasty on L4 inferior articular process under a lumber percutaneous endoscopy. In addition, the influence of both types of surgery on the stress of L3/4 disc is small.
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Affiliation(s)
- YiZhou Xie
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Qun Zhou
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan Province
| | - Xinling Wang
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Qiang Jian
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Xiaohong Fan
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Yang Yu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - Dangwei Gu
- Hospital of Chengdu University of Traditional Chinese Medicine
| | - WeiDong Wu
- Southern Medical University, Guangzhou, Guangdong Province, P.R. China
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11
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Chen S, Suo S, Li C, Wang Y, Li J, Zhang F, Zhang W. Clinical Application of Percutaneous Transforaminal Endoscopic Surgery in Lumbar Discal Cyst. World Neurosurg 2020; 138:e665-e673. [PMID: 32194264 DOI: 10.1016/j.wneu.2020.03.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Discal cyst is very rare and can cause intractable low back pain and radiating leg pain. Symptoms are hard to distinguish from lumbar disc herniation. The best treatment for discal cyst is controversial. Most lumbar discal cysts are treated surgically, while most studies of percutaneous transforaminal endoscopic surgery are case reports. This study investigated the clinical value of percutaneous transforaminal endoscopic surgery for lumbar discal cyst. METHODS A retrospective study was conducted in 9 patients with a discal cyst from June 2016 to November 2018. All patients had been treated by percutaneous transforaminal endoscopic surgery via a superior vertebral pedicle notch approach. Surgical outcomes were evaluated preoperatively and postoperatively using a visual analog scale for leg pain and the Oswestry Disability Index. At the final follow-up, patients were evaluated for clinical efficacy using modified Macnab criteria. RESULTS All 9 patients had remission of symptoms after removal of discal cysts. Postoperative magnetic resonance imaging showed that all patients had complete excision of discal cysts and complete decompression of the treated segment. There were no recurrent lesions during follow-up. Mean operative time was 68.67 ± 14.02 minutes. Mean hospitalization time was 4.22 ± 1.64 days. Preoperative visual analog scale and Oswestry Disability Index score improved significantly after surgery. Visual analog scale leg score improved from 7.88 ± 1.05 preoperatively to 1.78 ± 0.66 at final follow-up (P < 0.05), and ODI score improved from 53.65 ± 12.46 to 16.25 ± 8.76 (P < 0.05). According to the modified Macnab criteria, 5 patients (55.6%) were rated excellent, 3 patients (33.3%) were rated good, and 1 patient (11.1%) was rated fair at final follow-up, with an overall excellent and good rate of 88.9%. There were no serious complications during follow-up. CONCLUSIONS Percutaneous transforaminal endoscopic surgery could be a safe, minimally invasive surgical treatment for discal cyst, particularly suitable for patients who cannot undergo general anesthesia.
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Affiliation(s)
- Song Chen
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China; Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Shiqi Suo
- Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan, China
| | - Chengli Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yunxia Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jiaqi Li
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Fei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Wei Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China.
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12
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Ravikanth R. A review of discogenic pain management by interventional techniques. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2020; 11:4-8. [PMID: 32549705 PMCID: PMC7274356 DOI: 10.4103/jcvjs.jcvjs_19_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/02/2020] [Indexed: 11/15/2022] Open
Abstract
This review article describes the various image guided interventional techniques used for treating chronic backache attributed to disc related pathologies. With the aim of minimum invasion and maximum relief, these procedures comprise predominantly of annuloplasty and disc decompression via different mechanisms. Newer therapies are discussed in this review article with the objective of restoring disc height and its biomechanical function by substitution of biochemical constituents, regeneration of cartilaginous end plate and finally artificial disc implantation.
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Affiliation(s)
- Reddy Ravikanth
- Department of Radiology, St. John's Hospital, Kattappana, Kerala, India
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13
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Patgaonkar P, Datar G, Agrawal U, Palanikumar C, Agrawal A, Goyal V, Patel V. Suprailiac versus transiliac approach in transforaminal endoscopic discectomy at L5-S1: a new surgical classification of L5-iliac crest relationship and guidelines for approach. JOURNAL OF SPINE SURGERY 2020; 6:S145-S154. [PMID: 32195423 DOI: 10.21037/jss.2019.09.14] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Approach to the L5-S1 level with transforaminal access can be challenging. Some surgeons employ the interlaminar or paraspinal endoscopic approach as an alternative apart from the other minimally invasive posterior surgical options. To precisely target and safely access disc herniations at L5-S1, the authors attempted to stratify patients into trans and supra iliac approach groups and propose a simple surgical classification based on the radiographic findings. Methods A prospective study was performed on a cohort of 90 patients with L5-S1 disc herniation who underwent transforaminal endoscopic discectomy through suprailiac or transiliac approach depending on the best trajectory to access the herniated disc. Preoperative radiological assessment was done on anteroposterior and lateral radiographs of the lumbosacral spine by two independent observers. The proposed classification and approach guidelines were used to stratify patients for the preferred access route. The outcome was measured as mean VAS and ODI scores pre-operative and at 6 months post-operative and compared using the null hypothesis (P value) and the paired t-test. The interrater reliability was calculated as the percentage agreement between different observers. Results The L5-S1 disc herniation was treated with the transforaminal approach in 46 patients via the suprailiac and in the remaining 44 patients via the transiliac approach. There were statistically significant VAS and ODI reductions in patients of both groups (P<0.05). Interrater reliability of 92.5% using percent agreement shows strong level of agreement. Conclusions This surgical approach classification based on radiographs aids in the preoperative planning for selection of patients to either suprailiac or transiliac approach for transforaminal endoscopic surgery at L5-S1 level.
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Affiliation(s)
- Prasad Patgaonkar
- Orthopaedic-Spine Surgeon, Indore Spine Centre, Global SNG Hospital, Indore, Madhya Pradesh, India
| | - Girish Datar
- Orthopaedic Surgeon, Center for Endoscopic Spine Surgery, Sushruta Hospital for Orthopaedics & Traumatology, Miraj, Maharashtra, India
| | - Utkarsh Agrawal
- Orthopaedic Surgeon, Indore Spine Centre, Global SNG Hospital, Indore, Madhya Pradesh, India
| | | | - Anshul Agrawal
- Pain Physician, Indore Spine Centre, Global SNG Hospital, Indore, India
| | - Vaibhav Goyal
- Orthopaedic Surgeon, Indore Spine Centre, Global SNG Hospital, Indore, Madhya Pradesh, India
| | - Vivek Patel
- Orthopaedic Surgeon, Indore Spine Centre, Global SNG Hospital, Indore, Madhya Pradesh, India
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Abstract
Lower back pain is a commonly reported symptom during pregnancy. However, herniated lumbar disk disease is an uncommon cause for such pain. Cauda equina syndrome (CES) during pregnancy is a rare clinical scenario. This review highlights the epidemiology, diagnostic and treatment strategies, and challenges encountered when managing herniated lumbar disk disease and CES in pregnancy. Magnetic resonance imaging is the diagnostic modality of choice. Nonoperative treatment strategies are successful in the vast majority of cases in patients with a herniated disk in the absence of CES. CES and progressive neurological deficits remain absolute indications for surgical intervention regardless of gestational age. For such patients or those with debilitating symptoms refractory to nonoperative treatment strategies, surgery has been demonstrated to be safe in the pregnant patient population. However, surgery should be performed with obstetric and midwifery support should complications occur to the fetus.
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Kapetanakis S, Gkantsinikoudis N, Charitoudis G. The Role of Full-Endoscopic Lumbar Discectomy in Surgical Treatment of Recurrent Lumbar Disc Herniation: A Health-Related Quality of Life Approach. Neurospine 2019; 16:96-104. [PMID: 30943711 PMCID: PMC6449825 DOI: 10.14245/ns.1836334.167] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 03/17/2019] [Indexed: 12/17/2022] Open
Abstract
Objective To investigate the utility of full-endoscopic lumbar discectomy (FELD) in surgical treatment of recurrent lumbar disc herniation (RLDH).
Methods Forty-five patients were prospectively studied. All patients were subjected to FELD for RLDH. They were assessed preoperatively and in regular intervals at 6 weeks and 3 months, 6 months, and 12 months postoperatively. Evaluation was conducted with visual analogue scale for leg (VAS-LP) and low back (VAS-BP) pain. Short-Form 36 Health Survey Questionnaire was utilized for health-related quality of life assessment.
Results All studied parameters featured statistically significant amelioration at all follow-up intervals. Maximal improvement was in general at 6 weeks observed, with subsequent lesser improvement until 6 months and stabilization until the end of follow-up. Comparative assessment indicated that VAS-BP displayed quantitatively lower improvement, whereas physical function, bodily pain, and role-emotional parameters demonstrated greater amelioration.
Conclusion FELD is associated with a favorable impact in postoperative daily life of patients with RLDH.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece.,Athens Medical Center, Athens, Greece
| | | | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Kapetanakis S, Chaniotakis C, Angoules AG. Full Endoscopic Discectomy Using Transforaminal Endoscopic Spine System Technique: A Mini Review of Complications. Open Orthop J 2019. [DOI: 10.2174/1874325001913010076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background:Full Endoscopic Discectomy (FED) is a minimally invasive technique for the treatment of Lumbar Disk Herniation (LDH) with increasing popularity among surgeons in the recent years. This alternative to conventional procedures surgical approach is generally a safe and efficient technique possessing many advantages such as less soft tissue trauma, preservation of dorsal musculature, and reduced perioperative morbidity and rapid recovery. However, FED is associated with a number of complications such as postoperative dysesthesia, nerve root injury, and dural tears.Methods:Α search of PubMed, Google Scholar and Scopus electronic databases was used to revised the literature on complications of full endoscopic discectomy using transforaminal endoscopic spine system techniqueConclusion:In this review complications associated with FED are analyzed, emphasizing on the potential beneficial role of Transforaminal Endoscopic Spine System (TESSYS) technique in reducing their frequency.
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17
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Kapetanakis S, Gkantsinikoudis N, Thomaidis T, Charitoudis G, Theodosiadis P. The Role of Percutaneous Transforaminal Endoscopic Surgery in Lateral Recess Stenosis in Elderly Patients. Asian Spine J 2019; 13:638-647. [PMID: 30909678 PMCID: PMC6680028 DOI: 10.31616/asj.2018.0179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Accepted: 11/26/2018] [Indexed: 12/29/2022] Open
Abstract
Study Design Prospective clinical study. Purpose To investigate the effect of percutaneous transforaminal endoscopic surgery (PTES) for lateral recess stenosis (LRS)(LRS) in elderly patients and to assess patients’ health-related quality of life (HRQoL). Overview of Literature PTES is an increasingly used surgical approach, primarily employed for lumbar disc herniation treatment. However, indications for PTES have been increasing in recent years. PTES has been recommended as a beneficial alternative to open decompression surgery in specific LRS cases; PTES is termed as percutaneous endoscopic ventral facetectomy (PEVF) in such cases. Methods In total, 65 elderly patients with LRS were prospectively studied. Patients presented severe comorbidities (coronary insufficiency, heart failure, diabetes mellitus, and respiratory failure); thus, general anesthesia administration would potentially cause considerable hazards. All the patients underwent successful PEVF in 2015–2016. The patients were assessed preoperatively and at 6 weeks; 3, 6, and 12 months; and 2 years postoperatively. Patients’ objective assessment was conducted according to specific clinical scales; the Visual Analog Scale (VAS) was separately used for leg and low-back pain (VAS-LP and VAS-BP, respectively), whereas the Short Form 36 Health Survey Questionnaire was used for the HRQoL evaluation. Results All studied parameters presented maximal improvement at 6 weeks postoperatively, with less enhancement at 3 and 6 months with subsequent stabilization. Statistical significance was found in all follow-up intervals for all parameters (p<0.05). Parameters with maximal absolute amelioration were VAS-LP, bodily pain, and role limitations due to physical health problems. In contrast, VAS-BP, general health, and mental health were comparatively less enhanced. Conclusions PEVF was associated with remarkably enhanced HRQoL 2 years postoperatively. PEVF is thus a safe and effective alternative for LRS surgical management in elderly patients with severe comorbidities.
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Affiliation(s)
- Stylianos Kapetanakis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | | | - Tryfon Thomaidis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
| | - Georgios Charitoudis
- Spine Department and Deformities, Interbalkan European Medical Center, Thessaloniki, Greece
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Wu XD, Chen Y, Yu WC, Liu Y, Cao P, Tian Y, Wang XW, Chen HJ, Ye XJ, Yuan W, Yeung A. Effectiveness of Bi-Needle Technique (Hybrid Yeung Endoscopic Spine System/Transforaminal Endoscopic Spine System) for Percutaneous Endoscopic Lumbar Discectomy. World Neurosurg 2018; 119:e53-e59. [PMID: 29981910 DOI: 10.1016/j.wneu.2018.06.220] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 06/26/2018] [Accepted: 06/27/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The bi-needle technique is a new technique for percutaneous endoscopic lumbar discectomy. This technique combines the advantages of Yeung endoscopic spine system (YESS) and transforaminal endoscopic spine system (TESSYS) techniques. The aim of this study was to evaluate effectiveness of the bi-needle technique for percutaneous endoscopic lumbar discectomy and compare it with the TESSYS technique. METHODS We reviewed 86 patients with single-level lumbar disc herniation treated by percutaneous endoscopic lumbar discectomy in our hospital from June 2013 to December 2015. Bi-needle technique was used in 49 patients (30 men, 19 women; average age 40.4 ± 5.2 years). TESSYS technique was used in 37 patients (19 men, 18 women; average age 42.8 ± 6.4 years). Clinical results were evaluated and compared between the 2 groups. RESULTS Symptoms in both groups were significantly improved at the last follow-up (P < 0.01). There was no statistical difference in visual analog scale and lumbar Japanese Orthopaedic Association scores between bi-needle and TESSYS groups at last follow-up (P = 0.69 and P = 0.33, respectively). Operative time was shorter in the bi-needle group (P < 0.01). Recurrence rate and reoperation rate were lower in the bi-needle group (P = 0.04 and P = 0.03, respectively). Discitis was diagnosed in 2 patients in the TESSYS group. There were no patients with postoperative discitis in the bi-needle group. CONCLUSIONS The bi-needle technique is safe and effective for treatment of lumbar disc herniation. Compared with TESSYS technique, operative time is shorter, and recurrence and reoperation rates are lower.
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Affiliation(s)
- Xiao-Dong Wu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yu Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen-Chao Yu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Yang Liu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Peng Cao
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Ye Tian
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Xin-Wei Wang
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hua-Jiang Chen
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Xiao-Jian Ye
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wen Yuan
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Anthony Yeung
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
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