Risk factors for ninety-day readmissions following full-endoscopic transforaminal lumbar discectomy for 1542 patients in the biggest spine institutes in Korea

INTRODUCTION

Endoscopic techniques are becoming popular among spine surgeons because of their advantages. Though the advantages of endoscopic spine surgery are evident and patients can be discharged home within hours of surgery, readmissions can be sought for incomplete relief of leg pain, recurrent disc herniation, and recurrent leg pain. We aim to find out the factors related to the readmission of patients treated for lumbar pathologies.

MATERIALS AND METHODS

This is a retrospective analysis of the data between the time duration of 2012 and 2022. Patients in the age group of 18-85 years, with lumbar disc herniation treated by transforaminal endoscopic lumbar procedures, were included. The patients who were readmitted within 90 days were included in the R Group and those who were not were included in the NR group. Univariable and multivariable logistic regression analyses were used to find the risk factors for 90-day readmission.

RESULTS

There were a total of 1542 patients enrolled in this study. Sex, number of episodes before admission, hypertension, smoking, BMI, migration, disc height, disc height index, spondylolisthesis, instability, pelvic tilt (PT), and disc cross-sectional area (CSA) were found significant on univariable analysis. Age, spondylolisthesis, instability and muscle CSA were the only variables that were found to be statistically significant on multivariable analysis.

CONCLUSIONS

This study shows that the elderly age group, presence of spondylolisthesis, segmental instability and decreased muscle cross-sectional area are independent risk factors for 90-day hospital readmissions. Patients having the above risk factors should be carefully counseled regarding the possibility of readmission in the future.

Fluoroscopy-Guided Percutaneous Transpedicular Biopsy Versus Posterolateral Endoscopy for Infective Spondylodiskitis Diagnosis: A Comparative Study

OBJECTIVE

We sought to determine the concordance in frequency of microbiologic isolation and species identification in specimens obtained by 2 methods.

METHODS

Intervertebral disk specimens were taken simultaneously from each patient using percutaneous needle and posterolateral endoscopic biopsies. The isolates were reported in frequencies and concordance using the chi square and Cohen kappa tests.

RESULTS

Thirty patients were recruited. The average age was 58.1 years, and 15 patients were women. The clinical evolution time was 7 ± 4 months. The causative organism was identified in 12 (40%) specimens obtained by fluoroscopy-guided percutaneous transpedicular biopsy and in 14 (46.6%) obtained by posterolateral endoscopy. The most common organism isolated was Staphylococcus aureus in 3 patients with the percutaneous technique and in 5 with the endoscopic one; Escherichia coli was isolated in 3 patients with each method. The kappa test showed a high degree of agreement between both methods (kappa = 0.86); the agreement in bacterial species identification was 100%.

CONCLUSIONS

Fluoroscopy-guided percutaneous biopsy and endoscopic sampling have a good degree of concordance for both, frequency of organism isolation and identification in patients with infectious spondylodiskitis.

Current and Future of Endoscopic Spine Surgery: What are the Common Procedures we Have Now and What Lies Ahead?

The aging population around the world leads to increasing incidence of degenerative spinal conditions. There is a need for a minimally invasive technique in treatment for spinal conditions to meet the medical complexity and comorbidities that comes with aging. Principles of endoscopy are similar to minimally invasive surgery, which is to decrease pressure on soft tissue crushing from prolonged retraction, avoid soft tissue stripping and dissection, and bone and ligamentous preservation for optimal decompression without excessive destruction. Endoscopic spine surgery techniques started slowly in development in the 1970s to 2000s, with a rapid phase of development since the turn of the 21st century with endoscopic solutions developing in cervical, thoracic, and lumbar conditions with increasing complexity in nature of operation. Technological enhancement with progressively supportive literature is pushing boundaries of endoscopy from the early days of soft tissue procedure to current fusion procedures, endoscopic spine surgery techniques is covering more areas of spine than ever previously possible with good clinical results. We present a review on the current techniques available and postulated near future development for endoscopic spine surgery.

Return to work and recovery time analysis after outpatient endoscopic lumbar transforaminal decompression surgery

BACKGROUND

This study aimed to analyze the return to work (RTW) and recovery time (RT) to narcotic independence following outpatient endoscopic decompression for contained lumbar herniated disc causing sciatica-type low back and leg pain.

METHODS

A retrospective study of 442 patients with symptomatic contained lumbar herniated disc was treated with the transforaminal endoscopic decompression surgery. The mean follow-up was 33.5 months, ranging from 24 to 85 months. The patients' age ranged from 30 to 85 years, with a mean age of 40.9 years. Statistical analysis of pre- and postoperative VAS, Macnab outcomes, improvement of postoperative walking endurance was performed. RTW rates were correlated with the type of work as classified according to energy consumption per minute (Kcal/min) as Light, Medium, and Heavy using guidelines adopted from the U.S. Department of Labor. Kaplan-Meier (KM) survival tables were calculated, and curves were plotted using IBM SPSS 25.0 to graphically illustrate the diverse RTW and RT dynamic when analyzed by the clinical outcome and the type of work performed by the patient preoperatively.

RESULTS

Excellent (237/442) and Good (133/442) results were obtained in 83.7% (370/442) of patients. Fair results were reported by 43 patients (9.7%), and Poor results by 29 (6.6%), respectively. The mean preoperative VAS was 8.08. The mean postoperative VAS was significantly reduced to 2.55 (P<0.0001). The overall RTW rate was 92.5% (409/442). Patients performing Heavy (RTW rate =87.5%) and Medium (RTW rate =86.0%) work had a lower RTW rate than patients who were performing Light jobs (370/442; RTW rate =95.8%). Preoperatively, only 31.7% (140/442) had unlimited walking endurance. Postoperative walking endurance was unlimited in 77.4% (342/442; P<0.0001). Another 20.4% (90/442) of patients had pain-free walking endurance up to one mile. K-M analysis showed an estimated median RTW of 6 days for Excellent, 9 days for Good, 17 days for Fair, and 18 days for Poor Macnab outcomes. RTW analysis by the type of work showed estimated median RTW of 20 days for patients in the Heavy, 13 days in the Medium, and 6 days in the Light workgroup. The mean RT was 33.52 days in the Heavy, 19.17 days in the Medium, and 9.86 days in the Light workgroup (P<0.0001). The mean RTW was 22.27 days (P=0.008) in the Heavy, 13.97 days (P=0.004) in the Medium, and 7.58 days (P=0.004) in the Light workgroup. Postoperative irritation of the dorsal root ganglion (DRG) occurred in 68 of the 442 study patients (15.38%). DRG irritation delayed RTW to a mean of 18.94 days (P<0.0001) and RT to 15.31 days (P<0.001).

CONCLUSIONS

Patient RTW and RT data are "real-world" economic indicators of successful clinical outcomes with the lumbar endoscopic transforaminal decompression procedure and compare favorably to previously reported benchmarks for other types of translaminar surgeries. These median postoperative RTW and RT times with narcotic independence were on the order of 10 days or less in the vast majority of patients Excellent and Good outcomes (83.7%). The most relevant surgical predictor of delayed RTW and RT is a postoperative DRG irritation which predominantly affected patients adversely in the Medium and Heavy workgroups. These RTW and RT data may assist in the management of return-to-work expectations with the spinal endoscopy procedure.