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Pain Physician Jan 2020Percutaneous endoscopic lumbar discectomy (PELD) often refers to percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar... (Review)
Review
BACKGROUND
Percutaneous endoscopic lumbar discectomy (PELD) often refers to percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). As a minimally invasive spinal procedure, PELD has gained increasing recognition for its small incision, quick recovery, short hospital stay, and equivalent clinical outcome compared to open surgery. In order to obtain satisfactory clinical efficacy, adequate consideration should be given regarding the indication of PELD. On the other hand, complications related to PELD will also significantly affect the safety and outcome of surgery.
OBJECTIVE
Our objective was to conduct a literature review of the indications and complications of PELD and to provide our experience in patient selection and solutions to complications related to PELD.
STUDY DESIGN
The study is a literature review focused on the indications and complications of PELD.
SETTING
The study is a literature review on the indications and complications of PELD.
METHODS
A comprehensive review of available literature on PELD was performed. Particular focus was given to the development of indications and prevention of complications. The literature was searched in PubMed database, and key words were set as "percutaneous endoscopic lumbar discectomy", "percutaneous endoscopic transforaminal discectomy", "percutaneous endoscopic interlaminar discectomy", "PELD", "PETD", "PEID", "YESS" and "TESSYS".
RESULTS
PELD is an effective and safe treatment for lumbar disc herniation, lumbar spinal stenosis, recurrent lumbar disc herniation, and other lumbar diseases. Complications related to PELD include dural tear, nerve root injury, recurrence, and so on.
LIMITATIONS
Some results drawn in this review are based on retrospective study or small sample size. Studies of larger sample size and more multicenter, randomized controlled trials should be conducted to evaluate the clinical efficacy and safety of PELD.
CONCLUSIONS
PELD is a promising surgical technique for lumbar diseases. Proper patient selection, excellent surgical skills, and rich experience are required for satisfactory outcomes.
KEY WORDS
Complications, indications, minimally invasive spine surgery, PELD.
Topics: Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbosacral Region; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 32013278
DOI: No ID Found -
Orthopaedics & Traumatology, Surgery &... Feb 2018Thoracic disc herniation is rare and mainly occurs between T8 and L1. The herniation is calcified in 40% of cases and is labeled as giant when it occupies more than 40%... (Review)
Review
Thoracic disc herniation is rare and mainly occurs between T8 and L1. The herniation is calcified in 40% of cases and is labeled as giant when it occupies more than 40% of the spinal canal. A surgical procedure is indicated when the patient has severe back pain, stubborn intercostal neuralgia or neurological deficits. Selection of the surgical approach is essential. Mid-line calcified hernias are approached from a transthoracic incision, while lateralized soft hernias can be approached from a posterolateral incision. The complication rate for transthoracic approaches is higher than that of posterolateral approaches; however, the former are performed in more complex herniation cases. The thoracoscopic approach is less invasive but has a lengthy learning curve. Retropleural mini-thoracotomy is a potential compromise solution. Fusion is recommended in cases of multilevel herniation, herniation in the context of Scheuermann's disease, when more than 50% bone is resected from the vertebral body, in patients with preoperative back pain or herniation at the thoracolumbar junction. Along with complications specific to the surgical approach, the surgical risks are neurological worsening, dural breach and subarachnoid-pleural fistulas. Giant calcified herniated discs are the largest contributor to myelopathy, intradural extension and postoperative complications. Some of the technical means that can be used to prevent complications are explored, along with how to address these complications.
Topics: Back Pain; Calcinosis; Diskectomy; Humans; Intervertebral Disc Displacement; Neuralgia; Patient Selection; Spinal Cord Diseases; Thoracic Vertebrae
PubMed: 29225115
DOI: 10.1016/j.otsr.2017.04.022 -
Pain Research & Management 2022To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who...
OBJECTIVES
To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who underwent microdiscectomy. . The pain intensity (PI) reduction is a parameter of surgical treatment efficacy. The two most commonly used scales of PI are NRS and VAS. Many studies have shown strong similarities between those two scales, but the direct interchange is difficult.
METHODS
Patients, who underwent microdiscectomy, were prospectively enrolled into the study and assessed using VAS and NRS for the back (NRS-B) and the leg (NRS-L), Short Form of McGill Pain Questionnaire (SF-MPQ) included Pain Rating Index (PRI) and Oswestry Disability Index (ODI) 1 day before and 1 month and 3 months after the procedure.
RESULTS
131 patients were included in the study. NRS-L, NRS-B, VAS, and ODI were significantly lower ( < 0.001) 1 month after microdiscectomy. NRS-L and NRS-B ratings remained at a similar level while VAS and ODI decreased after 3 months. The rate of decline of PI measured by NRS-L correlated statistically significant (rs = 0.366; < 0.001) with ODI 1 month after surgery. Before surgery, the most significant correlation was found between ODI and NRS-L (rs = 0.494; < 0.001), the lowest with NRS-B (rs = 0.319; < 0.001). 3 months after surgery, there was higher correlations between ODI and VAS (rs = 0.634) than NRS-L (rs = 0.265). PRI correlated significantly ( < 0.001) and more stronger with VAS than with NRS-L and NRS-B in every points of assessment.
CONCLUSION
The results showed that PI measurements by NRS-L/NRS-B and VAS mutually correlate and impair functionality evaluated by ODI (convergent validity) but in different modes (differential validity). NRS and VAS are not parallel scales and assess different aspects of pain. The measurement of NRS-L 1 month after microdiscectomy seems to give quick insight into the effectiveness of the procedure.
Topics: Disability Evaluation; Diskectomy; Humans; Lumbar Vertebrae; Pain; Pain Measurement; Treatment Outcome; Visual Analog Scale
PubMed: 35391853
DOI: 10.1155/2022/5337483 -
Medicine Feb 2019Systematic review with network meta-analysis.
STUDY DESIGN
Systematic review with network meta-analysis.
OBJECTIVE
To compare patient outcomes of lumbar discectomy with bone-anchored annular closure (LD + AC), lumbar discectomy (LD), and continuing conservative care (CC) for treatment of lumbar disc herniation refractory to initial conservative management.
SUMMARY OF BACKGROUND DATA
Several treatment options are available to patients with refractory symptoms of lumbar disc herniation, but their comparative efficacy is unclear.
METHODS
A systematic review was performed to compare efficacy of LD + AC, LD, and CC for treatment of lumbar disc herniation. Outcomes included leg pain, back pain, disability (each reported on a 0-100 scale), reherniation, and reoperation. Data were analyzed using random effects network meta-analysis.
RESULTS
This review included 14 comparative studies (8 randomized) involving 3947 patients-11 studies of LD versus CC (3232 patients), 3 studies of LD + AC versus LD (715 patients), and no studies of LD + AC versus CC. LD was more effective than CC in reducing leg pain (mean difference [MD] -10, P < .001) and back pain (MD -7, P < .001). LD + AC was more effective than LD in reducing risk of reherniation (odds ratio 0.38, P < .001) and reoperation (odds ratio 0.33, P < .001). There was indirect evidence that LD + AC was more effective than CC in reducing leg pain (MD -25, P = .003), back pain (MD -20, P = .02), and disability (MD -13, P = .02) although the treatment effect was smaller in randomized trials.
CONCLUSIONS
Results of a network meta-analysis show LD is more effective than CC in alleviating symptoms of lumbar disc herniation refractory to initial conservative management. Further, LD + AC lowers risk of reherniation and reoperation versus LD and may improve patient symptoms more than CC.
Topics: Age Factors; Bone-Anchored Prosthesis; Conservative Treatment; Disability Evaluation; Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Network Meta-Analysis; Pain; Reoperation; Sex Factors
PubMed: 30762743
DOI: 10.1097/MD.0000000000014410 -
Journal of Orthopaedic Surgery and... Jan 2018The unilateral biportal endoscopic (UBE) technique is a minimally invasive procedure for spinal surgery, while open microscopic discectomy is the most common surgical... (Comparative Study)
Comparative Study
BACKGROUND
The unilateral biportal endoscopic (UBE) technique is a minimally invasive procedure for spinal surgery, while open microscopic discectomy is the most common surgical treatment for ruptured or herniated discs of the lumbar spine. A new endoscopic technique that uses a UBE approach has been applied to conventional arthroscopic systems for the treatment of spinal disease. In this study, we aimed to compare and evaluate the perioperative parameters and clinical outcomes, including recovery from surgery, pain and life quality modification, patient's satisfaction, and complications, between UBE and open lumbar microdiscectomy (OLM) for single-level discectomy procedures.
METHODS
This study included 141 patients with degenerative disc disease requiring discectomy at a single level from L2-L3 to L5-S1. A total of 60 and 81 patients underwent UBE and OLM, respectively. Analysis was based on comparison of perioperative metrics, operation time (OT); estimated blood loss (EBL); length of hospital stay (HS); clinical outcomes, including assessment using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI); patient satisfaction (the MacNab score); and the incidence of reoperation and complications.
RESULTS
The study cohort was 56.7% women, and the mean patient age was 50.98 ± 18.23 years. The mean VAS (the back and leg), MacNab score, and ODI improved significantly from the preoperative period to the last follow-up (12.92 ± 3.92) in both groups (p < 0.001). One week after operation, the back VAS score in the UBE group showed significantly more improvement than that in the OLM group. However, the 1-week, 3-month, and 12-month VAS (the back and leg), ODI improvement, modified MacNab score, and OT were not significantly different between the two groups. In the UBE group, EBL (34.67 ± 16.92) was smaller and HS (2.77 ± 1.2) was shorter than that of the OLM group (140.05 ± 57.8, 6.37 ± 1.39). However, OT (70.15 ± 22.0) was longer in the UBE group than in the OLM group (60.38 ± 15.5), and the difference was statistically significant. Meanwhile, the differences in the rate of surgical conversion and complications between the two groups were not statistically significant.
CONCLUSIONS
The UBE for single-level discectomy yielded similar clinical outcomes to OLM, including pain control, functional disability, and patient satisfaction, but incurred minimal EBL, HS, and postoperative back pain.
TRIAL REGISTRATION
Not applicable.
Topics: Adult; Aged; Case-Control Studies; Diskectomy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Neuroendoscopy; Postoperative Complications; Retrospective Studies
PubMed: 29386033
DOI: 10.1186/s13018-018-0725-1 -
Journal of Orthopaedic Surgery and... Jan 2022Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while...
BACKGROUND
Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH.
METHODS
The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria.
RESULTS
The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups.
CONCLUSIONS
Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.
Topics: Adult; Aged; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain; Retrospective Studies; Treatment Outcome
PubMed: 35033143
DOI: 10.1186/s13018-022-02929-5 -
European Journal of Physical and... Dec 2014Various lumbar exercise programs are prescribed for rehabilitation purposes following microdiscectomy applied for the treatment of lumbar disk herniation. The literature... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Various lumbar exercise programs are prescribed for rehabilitation purposes following microdiscectomy applied for the treatment of lumbar disk herniation. The literature contains several studies on this subject. However, there are no studies investigating the effects of supervised dynamic lumbar stabilization exercises on fear and fear/regression attitudes of patients and on their return to work.
AIM
This study investigates the effects of supervised dynamic lumbar stabilization exercises during postoperative rehabilitation on spinal mobility, pain, functional status, return to work, quality of life, and fear/regression attitude of patients who underwent lumbar microdiscectomy for the first time.
SETTING
The study was conducted at physical therapy and rehabilitation clinics.
STUDY DESIGN
A randomized clinical trial comparing exercise programs after lumbar microdiscectomy.
PATIENTS SAMPLE
Forty-four lumbar microdiscectomy patients were randomized into two groups.
OUTCOME MEASURES
Each group was assessed in terms of low back pain, leg pain, spinal mobility, Oswestry Disability Index (ODI), and Nottingham Health Profile (NHP), at the postoperative first, second, and sixth months. Fear/regression beliefs and level of pain were evaluated through the Fear Avoidance Belief Questionnaire (FABQ).
METHODS
Forty-four patients were randomly divided into two equal groups of 22 subjects, respectively, as a study group with Dynamic Lumbar Stabilization (DLS) exercises and home exercises, and a control group with only home exercises for a period of four weeks.
RESULTS
Leg pain decreased more in the study group compared with the control group (P=0.004). Spinal mobility scores demonstrated greater increases in the study group (P<0.001). Statistically greater reductions were observed in the study group regarding ODI and FABQ scores (P<0.017).
CONCLUSION
DLS exercises may be recommended to patients following spinal surgery due to their benefits in reducing pain, increasing spinal mobility, and ensuring faster return to work periods.
Topics: Adult; Analysis of Variance; Diskectomy; Exercise Therapy; Fear; Female; Humans; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Microsurgery; Prospective Studies; Quality of Life; Return to Work; Time Factors
PubMed: 25201615
DOI: No ID Found -
The Pan African Medical Journal 2015
Topics: Accidents, Traffic; Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Male; Middle Aged
PubMed: 26966491
DOI: 10.11604/pamj.2015.22.295.7833 -
The Journal of the American Academy of... Jul 2022Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP...
INTRODUCTION
Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP costs for commercially insured patients receiving orthopaedic surgery. The aim of this study is to analyze the trends in OOP costs for common, elective orthopaedic surgeries performed in the hospital inpatient setting.
METHODS
This study used an employer-sponsored insurance claims database to analyze billing data of commercially insured patients who underwent elective orthopaedic surgery between 2014 and 2019. Patients who received single-level anterior cervical diskectomy and fusion (ACDF), single-level posterior lumbar fusion (PLF), total knee arthroplasty (TKA), and total hip arthroplasty (THA) were identified. OOP costs associated with the surgical episode were calculated as the sum of deductible payments, copayments, and coinsurance. Monetary data were adjusted to 2019 dollars. General linear regression, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests were used for analysis, as appropriate.
RESULTS
In total, 10,225 ACDF, 28,841 PLF, 70,815 THA, and 108,940 TKA patients were analyzed. Most patients in our study sample had preferred provider organization insurance plans (ACDF 70.3%, PLF 66.9%, THA 66.2%, and TKA 67.0%). The mean OOP costs for patients, by procedure, were as follows: ACDF $3,180 (SD = 2,495), PLF $3,166 (SD = 2,529), THA $2,884 (SD = 2,100), and TKA $2,733 (SD = 1,994). Total OOP costs increased significantly from 2014 to 2019 for all procedures (P < 0.0001). Among the insurance plans examined, patients with high-deductible health plans had the highest episodic OOP costs. The ratio of patient contribution (OOP costs) to total insurer contribution (payments from insurers to providers) was 0.07 for ACDF, 0.04 for PLF, 0.07 for THA, and 0.07 for TKA.
CONCLUSION
Among commercially insured patients who underwent elective spinal fusion and major lower extremity joint arthroplasty surgery, OOP costs increased from 2014 to 2019. The OOP costs for elective orthopaedic surgery represent a substantial and increasing financial burden for patients.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Diskectomy; Elective Surgical Procedures; Health Expenditures; Humans; Linear Models; Retrospective Studies; Spinal Fusion; Statistics, Nonparametric
PubMed: 35797680
DOI: 10.5435/JAAOS-D-22-00085 -
International Journal of Surgery... Dec 2017Anterior cervical discectomy with fusion (ACDF) and laminoplasty (LAMP) are used for the treatment of multilevel cervical myelopathy. Despite their widespread... (Meta-Analysis)
Meta-Analysis Review
OBJECT
Anterior cervical discectomy with fusion (ACDF) and laminoplasty (LAMP) are used for the treatment of multilevel cervical myelopathy. Despite their widespread applications certain differences are noted between the ACDF and LAMP procedures. A meta-analysis was conducted in order to compare the clinical outcomes, complications, and surgical trauma between ACDF and LAMP for the treatment of multilevel cervical myelopathy.
METHODS
Medline, EMBASE, Google Scholar, and Cochrane databases were used for the search of relevant studies until September 2016. The studies aimed to compare the ACDF and LAMP procedures for the treatment of multilevel cervical myelopathy. Title and abstract screening was carried out concomitantly, whereas full text screening was carried out independently. A random effect model was used for heterogeneous data. The data that did not follow heterogeneous pattern were pooled by a fixed effect model in order to examine the mean difference (MD) for continuous outcomes and the odds ratio (OR) for dichotomous outcomes, respectively.
RESULTS
A total of 6 articles out of 1351 citations (379 participants) were eligible. Significant differences were noted between the two groups in the cobb angle of C2-C7 (MD = 4.00, 95%, CI = 0.83 to 7.17; p = 0.01) and with regard to the incidence of associated complications (OR = 3.61, 95%, CI = 1.72 to 7.59; p = 0.0007). However, no apparent differences were noted in the variables blood loss (MD = -24.16, 95% CI = -174.47 to 126.15; p = 0.75), operation time ((MD = 32.81, 95% CI = -26.76 to 92.38; p = 0.28), recovery rate of JOA score (MD = 4.00, 95%, CI = 0.83 to 7.17; p = 0.01) and incidence of associated complications (OR = 3.61, 95%, CI = 1.72 to 7.59).
CONCLUSIONS
The present meta-analysis demonstrates that the rate of complications is lower in the laminoplasty. However, the cobb angle of C2-C7 was decreased in the ACDF group at the final follow-up period compared with the baseline. The outcomes of the variables blood loss, operation time, range of motion and recovery rate of JOA score, were similar in the two groups.
Topics: Blood Loss, Surgical; Cervical Vertebrae; Diskectomy; Humans; Laminoplasty; Operative Time; Postoperative Complications; Spinal Cord Diseases; Spinal Fusion
PubMed: 28687344
DOI: 10.1016/j.ijsu.2017.06.030