-
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 -
Spine Apr 2021Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH).
SUMMARY OF BACKGROUND DATA
The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM.
METHODS
Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months).
RESULTS
We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24).
CONCLUSION
There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.
Topics: Cost-Benefit Analysis; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery; Pain Measurement; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 33290374
DOI: 10.1097/BRS.0000000000003843 -
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 -
BMJ (Clinical Research Ed.) Feb 2022To assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused by lumbar... (Comparative Study)
Comparative Study Randomized Controlled Trial
OBJECTIVE
To assess whether percutaneous transforaminal endoscopic discectomy (PTED) is non-inferior to conventional open microdiscectomy in reduction of leg pain caused by lumbar disc herniation.
DESIGN
Multicentre randomised controlled trial with non-inferiority design.
SETTING
Four hospitals in the Netherlands.
PARTICIPANTS
613 patients aged 18-70 years with at least six weeks of radiating leg pain caused by lumbar disc herniation. The trial included a predetermined set of 125 patients receiving PTED who were the learning curve cases performed by surgeons who did not do PTED before the trial.
INTERVENTIONS
PTED (n=179) compared with open microdiscectomy (n=309).
MAIN OUTCOME MEASURES
The primary outcome was self-reported leg pain measured by a 0-100 visual analogue scale at 12 months, assuming a non-inferiority margin of 5.0. Secondary outcomes included complications, reoperations, self-reported functional status as measured with the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery. Outcomes were measured until one year after surgery and were longitudinally analysed according to the intention-to-treat principle. Patients belonging to the PTED learning curve were omitted from the primary analyses.
RESULTS
At 12 months, patients who were randomised to PTED had a statistically significantly lower visual analogue scale score for leg pain (median 7.0, interquartile range 1.0-30.0) compared with patients randomised to open microdiscectomy (16.0, 2.0-53.5) (between group difference of 7.1, 95% confidence interval 2.8 to 11.3). Blood loss was less, length of hospital admission was shorter, and timing of postoperative mobilisation was earlier in the PTED group than in the open microdiscectomy group. Secondary patient reported outcomes such as the Oswestry Disability Index, visual analogue scale for back pain, health related quality of life, and self-perceived recovery, were similarly in favour of PTED. Within one year, nine (5%) in the PTED group compared with 14 (6%) in the open microdiscectomy group had repeated surgery. Per protocol analysis and sensitivity analyses including the patients of the learning curve resulted in similar outcomes to the primary analysis.
CONCLUSIONS
PTED was non-inferior to open microdiscectomy in reduction of leg pain. PTED resulted in more favourable results for self-reported leg pain, back pain, functional status, quality of life, and recovery. These differences, however, were small and may not reach clinical relevance. PTED can be considered as an effective alternative to open microdiscectomy in treating sciatica.
TRIAL REGISTRATION
NCT02602093ClinicalTrials.gov NCT02602093.
Topics: Adolescent; Adult; Aged; Diskectomy; Endoscopy; Female; Humans; Leg; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Pain; Pain Measurement; Quality of Life; Sciatica; Self Report; Treatment Outcome; Young Adult
PubMed: 35190388
DOI: 10.1136/bmj-2021-065846 -
Medicine Feb 2023The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective...
The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective review aims to assess the safety and effectiveness of PELD for treating L5-S1 disc herniation with a range of characteristics and to determine the prevalence of lumbosacral transitional vertebrae (LSTV) anatomical anomalies to facilitate pre-surgical planning. From July 2005 to June 2019, 345 patients with L5-S1 disc herniations were treated with PELD. The primary outcome was 1-year postoperative visual analogue scale scores for low back and lower limb pain. The secondary outcomes included the surgical approach used, lumbosacral bony anomalies, presence of a ruptured disc or severely calcified disc, pediatric lumbar disc herniation, recurrent disc herniation management, and the long-term outcome. visual analogue scale scores for most patients were significantly improved after surgery. The prevalence of LSTVs was 4.05% (14/345 patients) in lumbar sacralization and 7.53% (26/345 patients) in sacral lumbarization. The prevalence of ruptured and severely calcified discs was 18.55% (64/345) and 5.79% (20/345), respectively. The prevalence of pediatric lumbar disc herniation was 2.02% (7/345). The recurrence rate was 4.34% (15/345). Two durotomy cases without sequelae and 8 cases of lower limb dysesthesia lasting longer than 3 months postoperatively were reported. PELD is safe and effective for treating L5-S1 disc herniation, including cases complicated by calcified lumbar disc herniation, disc rupture with migration, and the presence of LSTV. Appropriate imaging is essential to identify case-specific factors, including the prevalent LSTV anatomical anomalies, before surgery.
Topics: Humans; Child; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Retrospective Studies; Lumbar Vertebrae; Endoscopy; Lumbosacral Region; Treatment Outcome
PubMed: 36749265
DOI: 10.1097/MD.0000000000032832 -
Journal of Korean Neurosurgical Society Sep 2017Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine... (Review)
Review
Surgical treatment of the degenerative disc disease has evolved from traditional open spine surgery to minimally invasive spine surgery including endoscopic spine surgery. Constant improvement in the imaging modality especially with introduction of the magnetic resonance imaging, it is possible to identify culprit degenerated disc segment and again with the discography it is possible to diagnose the pain generator and pathological degenerated disc very precisely and its treatment with minimally invasive approach. With improvements in the optics, high resolution camera, light source, high speed burr, irrigation pump etc, minimally invasive spine surgeries can be performed with various endoscopic techniques for lumbar, cervical and thoracic regions. Advantages of endoscopic spine surgeries are less tissue dissection and muscle trauma, reduced blood loss, less damage to the epidural blood supply and consequent epidural fibrosis and scarring, reduced hospital stay, early functional recovery and improvement in the quality of life & better cosmesis. With precise indication, proper diagnosis and good training, the endoscopic spine surgery can give equally good result as open spine surgery. Initially, endoscopic technique was restricted to the lumbar region but now it also can be used for cervical and thoracic disc herniations. Previously endoscopy was used for disc herniations which were contained without migration but now days it is used for highly up and down migrated disc herniations as well. Use of endoscopic technique in lumbar region was restricted to disc herniations but gradually it is also used for spinal canal stenosis and endoscopic assisted fusion surgeries. Endoscopic spine surgery can play important role in the treatment of adolescent disc herniations especially for the persons who engage in the competitive sports and the athletes where less tissue trauma, cosmesis and early functional recovery is desirable. From simple chemonucleolysis to current day endoscopic procedures the history of minimally invasive spine surgery is interesting. Appropriate indications, clear imaging prior to surgery and preplanning are keys to successful outcome. In this article basic procedures of percutaneous endoscopic lumbar discectomy through transforaminal and interlaminar routes, percutaneous endoscopic cervical discectomy, percutaneous endoscopic posterior cervical foraminotomy and percutaneous endoscopic thoracic discectomy are discussed.
PubMed: 28881110
DOI: 10.3340/jkns.2017.0203.004 -
European Review For Medical and... Jul 2018To explore the effects of postoperative functional exercise on patients who underwent percutaneous transforaminal endoscopic discectomy for lumbar disc herniation. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To explore the effects of postoperative functional exercise on patients who underwent percutaneous transforaminal endoscopic discectomy for lumbar disc herniation.
PATIENTS AND METHODS
From January to May 2011, patients who had a lumbar disc herniation and then underwent percutaneous transforaminal endoscopic discectomy were divided randomly into two groups: the intervention group (n=46) and the control group (n=46). The intervention group conducted early functional exercises of passive and autonomic activities after their operations, while the control group conducted routine functional exercises after their operations. Short-term and long-term curative effects and quality of life were compared; risk factors that might affect the rehabilitation effects on the patients were analyzed using logistic regression.
RESULTS
The lumbar curvature, lumbar lordosis index and sacral inclination angle of the intervention group were better than that those same spinal stability factors in the control group six months after their operations (p<0.05). Scores for residual lumbocrural pain, straight leg raising, muscle strength (skin) sensory, nerve reflex and lumbar function of patients in the intervention group were better than those scores of the control group (p<0.05). The scores for physiological function, emotional function, activity and social function, mental health and quality of life of the intervention group were better than those of the control group (p<0.05). After 1 year of follow-up, the total effective rate for the intervention group was 82.6%, significantly higher than the control group, which had a total effective rate of 71.7% (p<0.05). After 3 years of follow-up, the score for the intervention group was 97.8%, significantly higher than the control group, which had an overall average score of 89.1% (p<0.05). Logistic regression analysis showed that the type of disc herniation, whether patients abided by their doctors' advice during treatment and protected their lumbar vertebra during treatment, and their age were all influential factors on patient rehabilitation.
CONCLUSIONS
Early functional exercises of passive and autonomic activities can improve the postoperative quality of life of patients with lumbar disc herniation and provides a basis for inclusion in postoperative treatment of lumbar disc herniation. Importance should be placed on factors, such as postoperative exercise, that can improve the curative effect of rehabilitation.
Topics: Adult; Aged; Diskectomy, Percutaneous; Endoscopy; Exercise Therapy; Female; Humans; Intervertebral Disc Displacement; Logistic Models; Lumbar Vertebrae; Male; Middle Aged; Quality of Life; Retrospective Studies
PubMed: 30004565
DOI: 10.26355/eurrev_201807_15354 -
Ugeskrift For Laeger Oct 2023The technical development has caused a reintroduction of endoscopic techniques directed towards degenerative spine disease. A summary of the endoscopic procedure is... (Review)
Review
The technical development has caused a reintroduction of endoscopic techniques directed towards degenerative spine disease. A summary of the endoscopic procedure is given in this review. The spinal canal is reached through an inter-laminar or transforaminal access. In comparison with open surgery the percutaneous transforaminal access seems especially advantageous for the removal of paramedian and/or foraminal herniated disc material. However, careful patient selection is required, as the restricted manoeuverability and working zone of the endoscope and patient specific pathoanatomy in some cases will disfavour endoscopy.
Topics: Humans; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Treatment Outcome; Lumbar Vertebrae; Endoscopy; Retrospective Studies
PubMed: 37921109
DOI: No ID Found -
Annals of Translational Medicine Mar 2018The treatment of cervical disc herniations has evolved in the last 2 decades. While the anterior cervical discectomy and fusion continues being the gold standard for the... (Review)
Review
The treatment of cervical disc herniations has evolved in the last 2 decades. While the anterior cervical discectomy and fusion continues being the gold standard for the treatment of radicular pain triggered by cervical disc herniation, other surgical approaches have been developed. Percutaneous endoscopic cervical discectomy has demonstrated the ability to decompress the exiting nerve root and dural sac correctly and encouraging clinical outcomes has been reported in the literature. One of the most important advantages offered by the endoscopic technique is the capability to resolve the patient's symptoms without the need for interbody fusion. Also, a specific and selective decompression under continuous visualization with minimal surgery-related trauma can be achieved. There are two percutaneous endoscopic cervical discectomy approaches: anterior and posterior. The decision to perform each other depends on pathology site. However, the endoscopic technique requires previous surgical training, a steep learning curve, and proper patient selection. The development of new hardware such as endoscopes with better optics, lighting systems, and endoscopic surgical tools have allowed using endoscopic techniques in more complex cases. The objective of this review is the technical description of the anterior and posterior percutaneous endoscopic cervical discectomy.
PubMed: 29707549
DOI: 10.21037/atm.2018.02.09