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Orthopaedic Surgery Jul 2021The aim of the present study was to compare the clinical outcomes and quality of life following percutaneous transforaminal endoscopic discectomy (PTED) and... (Comparative Study)
Comparative Study
OBJECTIVE
The aim of the present study was to compare the clinical outcomes and quality of life following percutaneous transforaminal endoscopic discectomy (PTED) and microscope-assisted tubular discectomy (MTD) for lumbar disc herniation (LDH).
METHODS
This study had a retrospective design. From June 2017 to June 2018, the clinical data of 120 patients with LDH treated with PTED (60 cases, PTED group) and MTD (60 cases, MTD group) were analyzed and followed up for at least 20 months. There were 59 men and 61 women. Patients were aged between 22 and 80 years. The operation time, intraoperative blood loss, incision length, frequency of intraoperative fluoroscopy, cost, hospital stay, types of herniated discs, complications, and clinical outcomes were evaluated. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified Macnab criteria. Short-Form 36 (SF-36) and the EQ-5D-5L were used to evaluate the quality of life of patients. The data between the two groups were compared by independent sample t-tests. Multiple comparisons between samples were analyzed by analysis of variance.
RESULTS
Compared with the MTD group, the PTED group had shorter incision length (9.20 ± 1.19 mm vs 26.38 ± 1.82 mm), less intraoperative blood loss (18.00 ± 4.97 mL vs 39.83 ± 6.51 mL), and shorter hospital stay (5.42 ± 5.08 days vs 10.58 ± 3.69 days) (P = 0.00). PTED was much more appropriate for foraminal and extraforaminal disc herniation. The incidence of paresthesia was lower in the PTED group (6.67% vs 16.67%). At each follow up, the VAS and ODI scores of all patients were significantly improved compared with those before surgery (P = 0.00). At 3 days postoperatively, the lumbar VAS score of the PTED group was significantly lower (1.58 ± 1.00 vs 2.37 ± 1.10, P = 0.00). The excellent rate of the PTED group reached 91.67%, and that of the MTD group reached 93.33%. Compared with the preoperative SF-36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved in both groups (P = 0.00). The EQ-5D-5L in the PTED group increased from 0.30 ± 0.17 before the operation to 0.69 ± 0.13 after 6 months of follow up (P = 0.00) and 0.73 ± 0.14 after 20 months of follow up. The EQ-5D-5L in the MTD group increased from 0.28 ± 0.17 before the operation to 0.68 ± 0.13 after a 6-month follow up (P = 0.00), and 0.73 ± 0.12 after a 20-month follow up.
CONCLUSION
Although both PTED and MTD are effective for LDH, PTED is much more appropriate for various types of LDH and has the advantages of the low incidence of low back pain, fewer complications, and early recovery.
Topics: Adult; Aged; Aged, 80 and over; Disability Evaluation; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Young Adult
PubMed: 34109744
DOI: 10.1111/os.12909 -
Pain Physician Sep 2021Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the...
BACKGROUND
Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited.
OBJECTIVES
To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application.
STUDY DESIGN
A retrospective cohort study.
SETTING
A center for spine surgery, rehabilitation department and pain medicine.
METHODS
Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations.
RESULTS
The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body.
LIMITATIONS
This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design.
CONCLUSIONS
Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results.
TRIAL REGISTRATION
The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820).
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 34554701
DOI: No ID Found -
BioMed Research International 2018Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points.
OBJECTIVES
The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population.
METHODS
In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library.
RESULTS
Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13).
LIMITATIONS
All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well.
CONCLUSION
While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery; Retrospective Studies; Treatment Outcome
PubMed: 30175149
DOI: 10.1155/2018/9073460 -
BMC Musculoskeletal Disorders Mar 2022Multiple surgical approaches have been studied and accepted for the removal of highly downward migrated lumbar disc herniation (LDH). Here, we investigated the efficacy...
BACKGROUND AND STUDY AIMS
Multiple surgical approaches have been studied and accepted for the removal of highly downward migrated lumbar disc herniation (LDH). Here, we investigated the efficacy and safety of full-endoscopic foraminoplasty for highly downward migrated LDH.
PATIENTS AND METHODS
Thirty-seven patients with highly down-migrated LDH treated by the full-endoscopic foraminoplasty between January 2018 and January 2020 were retrospectively investigated. Clinical parameters were evaluated preoperatively and 1, 6, and 12 months postoperatively, using pre- and post-operative Oswestry Disability Index (ODI) scores for functional improvement, visual analog scale (VAS) for leg and back pain, and modified MacNab criteria for patients satisfactory.
RESULTS
Thirty-seven patients with highly downward migrated LDH were successfully removed via the transforaminal full-endoscopic discectomy. The average VAS back and leg pain scores were significantly reduced from 7.41 ± 1.17 and 8.68 ± 1.06 before operation to 3.14 ± 0.89 and 2.70 ± 0.46 at postoperative 1 month, and 1.76 ± 0.59 and 0.92 ± 0.28 at postoperative 12 months, respectively (P < 0.05). The average ODI scores were reduced from 92.86 ± 6.41 to 15.30 ± 4.43 at postoperative 1 month, and 9.81 ± 3.24 at postoperative 12 months (P < 0.05). Based on the modifed MacNab criteria, 36 out of 37 patients (97.30%) were rated as excellent or good outcomes.
CONCLUSION
The full-endoscopic foraminoplasty can be used successfully for surgical removal of high grade down-migrated LDH, and it could serve as an efficient alternative technique for patients with highly downward migrated LDH.
Topics: Back Pain; Diskectomy, Percutaneous; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 35351069
DOI: 10.1186/s12891-022-05254-4 -
Neurospine Mar 2023The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and...
The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and fusion rate. However, significant perioperative morbidity related to extensive surgical exposure has been reported. Therefore, anterior endoscopic cervical discectomy (AECD) using a working channel endoscope has been developed to reduce surgical complications and tissue damage. The objective of this study was to describe a cutting-edge technique for AECD of soft CDH. The primary indication is cervical radiculopathy with or without axial neck pain due to soft CDH. The surgical procedure consists of 2 parts: (1) a safe anterior percutaneous approach under fluoroscopic control and (2) selective endoscopic discectomy and foraminal decompression using specialized mechanical tools under endoscopic visualization. The clinical outcomes are comparable to those of conventional surgery and show the benefits of minimally invasive spine procedure. Perioperative data revealed typical minimalism, including reduced muscle damage, blood loss, operative time, and recovery time. With technical advancements in surgical instruments and optics, AECD will become more practical and safer. AECD is effective in selected CDH cases with cervical radiculopathy. However, high-quality clinical studies are needed to verify the effectiveness of this endoscopic cervical spinal procedure.
PubMed: 37016849
DOI: 10.14245/ns.2346118.059 -
Orthopaedic Surgery May 2023Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management... (Review)
Review
OBJECTIVE
Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management of PDPs.
METHODS
Nine patients with PDP who received surgical treatment at our institution from January 2014 to December 2021 were retrospectively reviewed. A systematic review of the literature on PDP was performed. The demographic data, clinical and imaging features, surgical options and patient prognosis were analyzed.
RESULTS
Among the nine patients treated at our center, seven were male and two were female. The mean patient age (± standard deviation) at the time of surgery was 28.3 ± 5.7 years (range 18-37 years). The first operation performed on seven patients was percutaneous endoscopic transforaminal discectomy (PETD) and two patients underwent microdiscectomy. The time to conservative treatment before surgical intervention was 20 ± 9.2 days. In three cases, the disc cysts were located in L4/5 and in six cases the lesions were located in L5/S1. Intervertebral disc cyst interventions included foraminal scope (three cases), open discectomy (three cases), conservative treatment with a quadrant channel (one case) and CT-guided puncture (one case). All patients fully recovered after surgery and the mean follow-up time was 3.5 ± 2.1 years. A literature review identified 14 relevant articles that reported 43 PDP cases of PDP.
CONCLUSION
PDP occurs in Asian males with mild intervertebral disc degeneration and occurs 1 month after discectomy. Treatment should be based on specific patient scenarios. Conservative treatment is necessary and surgery should be performed with caution.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Intervertebral Disc Displacement; Retrospective Studies; Spinal Puncture; Lumbar Vertebrae; Diskectomy, Percutaneous; Endoscopy; Cysts; Treatment Outcome
PubMed: 36999347
DOI: 10.1111/os.13689 -
The Spine Journal : Official Journal of... Jul 2023Percutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness and safety of intrathecal morphine for percutaneous endoscopic lumbar discectomy under low-dose ropivacaine: a prospective, randomized, double-blind clinical trial.
BACKGROUND CONTEXT
Percutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade and could be ideal for maintaining safety of PELD, but its analgesic efficacy is questionable. An adjunct analgesic approach is needed to maximize the benefits of low-dose spinal ropivacaine for PELD.
PURPOSE
This study aimed to explore the effectiveness and safety of 100 µg intrathecal morphine (ITM) as an adjuvant analgesic method for PELD under low-dose spinal ropivacaine.
STUDY DESIGN
A double-blind, randomized, placebo-controlled trial.
TRIAL REGISTRATION
ChiCTR2000039842 (www.chictr.org.cn).
SAMPLE
Ninety patients scheduled for elective single-level PELD under low-dose spinal ropivacaine.
OUTCOME MEASURES
The primary outcome was the overall intraoperative visual analogue scale (VAS) score for pain. Secondary outcomes were intraoperative VAS scores assessed at multiple timepoints; intraoperative rescue analgesic requirement; postoperative VAS scores; disability scale; patients' satisfaction with anesthesia; adverse events; and radiographic outcomes.
METHODS
Patients were randomized to receive low-dose ropivacaine spinal anesthesia with (ITM group, n=45) or without (control group, n=45) 100 µg ITM.
RESULTS
The overall intraoperative VAS score in the ITM group was significantly lower than that in the control group (0 [0, 1] vs 2 [1, 3], p<.001). During operation, the VAS scores at cannula insertion, 30 minutes after insertion, 60 minutes after insertion, and 120 minutes after insertion were all significantly lower in the ITM group (all p<.05). Less patients in the ITM group required rescue analgesia during operation compared with those in the control group (14% vs 42%, p= .003). The VAS score for back pain in the ITM group was lower than that in the control group at 1 hour, 12 hours, and 24 hours postoperatively. Besides, the satisfaction score in the ITM group was significantly higher than that in the control group (p=.017). For adverse events, 8/43 of ITM and 1/44 of control participants experienced pruritus (p=.014), with a relative risk (95% confidence interval) of 8.37 (1.09-64.16). The incidence of other adverse events was similar between the two groups. Of note, respiratory depression occurred in one ITM-treated patient.
CONCLUSION
The addition of 100 µg ITM to low-dose ropivacaine appears to be effective in analgesia without compromised motor function for PELD; however, ITM increased the risk of pruritus and clinicians should be vigilant about its potential risk of respiratory depression.
Topics: Humans; Ropivacaine; Morphine; Analgesics, Opioid; Diskectomy, Percutaneous; Prospective Studies; Pain, Postoperative; Injections, Spinal; Intervertebral Disc Displacement; Lumbar Vertebrae; Analgesics; Diskectomy; Pruritus; Respiratory Insufficiency; Treatment Outcome; Double-Blind Method
PubMed: 36931566
DOI: 10.1016/j.spinee.2023.03.001 -
Orthopaedic Surgery Jul 2023Treatment of adjacent segment disease (ASD) is still controversial. The aim of this study was to evaluate the short-term efficacy and safety and to analyze the technical...
PURPOSE
Treatment of adjacent segment disease (ASD) is still controversial. The aim of this study was to evaluate the short-term efficacy and safety and to analyze the technical advantages, surgical approach, and indications of percutaneous full endoscopic lumbar discectomy (PELD) in the treatment of ASD after lumbar fusion in elderly patients.
METHODS
A retrospective of 32 patients with symptomatic ASD were accepted for PELD from October 2017 to January 2020. All patients used the transforaminal approach and recorded the operation time and intraoperative conditions. Preoperative, 3, 12, 24 months of postoperative and at the last follow-up, the pain of back and leg of visual analog scale (VAS), Oswestry dysfunction index (ODI), and Japanese Orthopaedic Association Assessment Treatment Score (JOA) were performed, and the paired student's t test was used to the compare the continuous variables preoperatively and postoperatively. The clinical efficacy was evaluated according to MacNab standards. The lumbar MRI was performed to evaluate the decompression of the nerve roots, and the lumbar lateral and dynamic X-rays were performed to evaluate the stability of the surgical segment.
RESULTS
A total of 32 patients were included in the study, including 17 males and 15 females. The follow-up time ranged from 24 to 50 months, with an average of (33.2 ± 8.1) months and an average operation time of (62.7 ± 28.1) minutes. Compared to preoperatively, the VAS score of the back and leg pain (p < 0.05), ODI (p < 0.05), and JOA (p < 0.05) postoperatively were significantly improved. At the last follow-up, according to the modified MacNab standard assessment, 24 cases were excellent, five cases were good, and three cases were fair, the excellent and good rate was 90.65%. As for complications, one case had a small rupture of the dural sac during the operation, which was found but not repaired during the operation, and one case recurred after the operation. At the last follow-up, there were three cases of intervertebral instability.
CONCLUSION
PELD showed satisfactory short-term efficacy and safety in the management of ASD after lumbar fusion in elderly patients. Therefore, PELD might be an alternative choice for elderly patients with symptomatic ASD after lumbar fusion, but surgical indications must be strictly controlled.
Topics: Male; Female; Humans; Aged; Retrospective Studies; Endoscopy; Diskectomy; Diskectomy, Percutaneous; Treatment Outcome; Pain; Lumbar Vertebrae; Intervertebral Disc Displacement
PubMed: 37232005
DOI: 10.1111/os.13725 -
Ideggyogyaszati Szemle May 2021Microdiscectomy (MD) is a stan-dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in-terlaminar lumbar...
BACKGROUND AND PURPOSE
Microdiscectomy (MD) is a stan-dard technique for the surgical treatment of lumbar disc herniation (LDH). Uniportal percutaneous full-endoscopic in-terlaminar lumbar discectomy (PELD) is another surgical op-tion that has become popular owing to reports of shorter hos-pitalization and earlier functional recovery. There are very few articles analyzing the total costs of these two techniques. The purpose of this study was to compare total hospital costs among microdiscectomy (MD) and uniportal percutaneous full-endoscopic interlaminar lumbar discectomy (PELD).
METHODS
Forty patients aged between 22-70 years who underwent PELD or MD with different anesthesia techniques were divided into four groups: (i) PELD-local anesthesia (PELD-Local) (n=10), (ii) PELD-general anesthesia (PELD-General) (n=10), (iii) MD-spinal anesthesia (MD-Spinal) (n=10), (iv) MD-general anesthesia (MD-General) (n=10). Health care costs were defined as the sum of direct costs. Data were then analyzed based on anesthetic modality to produce a direct cost evaluation. Direct costs were compared statistically between MD and PELD groups.
RESULTS
The sum of total costs was $1,249.50 in the PELD-Local group, $1,741.50 in the PELD-General group, $2,015.60 in the MD-Spinal group, and $2,348.70 in the MD-General group. The sum of total costs was higher in the MD-Spinal and MD-General groups than in the PELD-Local and PELD-General groups. The costs of surgical operation, surgical equipment, anesthesia (anesthetist's costs), hospital stay, anesthetic drugs and materials, laboratory wor-kup, nur-sing care, and two main groups (PELD-MD) me-dication diffe-red significantly among the two main groups (PELD-MD) (p<0.01).
CONCLUSION
This study demonstrated that PELD is less costly than MD.
Topics: Adult; Aged; Diskectomy; Diskectomy, Percutaneous; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Middle Aged; Retrospective Studies; Treatment Outcome; Turkey; Young Adult
PubMed: 34106548
DOI: 10.18071/isz.74.0197 -
Journal of Pain Research 2022Both percutaneous endoscopic lumbar discectomy (PELD) and open fenestration discectomy (OFD) are effective and safe surgical procedures for the treatment of LDH. The...
Comparison of Percutaneous Endoscopic Interlaminar Discectomy and Open Fenestration Discectomy for Single-Segment Huge Lumbar Disc Herniation: A Two-year Follow-up Retrospective Study.
PURPOSE
Both percutaneous endoscopic lumbar discectomy (PELD) and open fenestration discectomy (OFD) are effective and safe surgical procedures for the treatment of LDH. The purpose of this retrospective study was to compare the surgical outcomes of percutaneous endoscopic interlaminar discectomy (PEID) and OFD for single-segment huge lumbar disc herniation (HLDH).
PATIENTS AND METHODS
We retrospectively analyzed 91 patients diagnosed with single-segment HLDH and treated with OFD or PEID. Visual analog scale (VAS), modified Japanese orthopedic association (mJOA) and Oswestry disability index (ODI) were used to assess clinical outcomes at preoperation and postoperatively at 3, 6, 12, and 24months. Modified Macnab criteria were applied to evaluate clinically satisfaction at the final follow-up.
RESULTS
In both groups, the VAS and ODI scores at 3, 6, 12, and 24months postoperatively showed a significant decrease and the mJOA score at 3, 6, 12, and 24months postoperatively was significantly increased compared to preoperative results (<0.001). According to Macnab criteria at the final follow-up, the overall clinically satisfactory rate was 86.67% in the OFD group and 86.96% in the PEID group. There were no significant differences in VAS, ODI, and mJOA scores between the two groups at preoperation and postoperative 3, 6, 12, and 24months, respectively. In the PEID group, the length of hospitalization and the length of incision were significantly shorter than that in the OFD group (<0.0001). However, there was no significant difference in operative time between groups (=0.81).
CONCLUSION
Collectively, postoperative clinical results were equally favorable for both procedures, with no statistically significant difference between PEID and OFD at the two-year of follow-up. No serious complication was observed in two groups. Compared with the traditional surgery, PEID has the following benefits: less trauma, less bleeding, speedy recovery, and shorter hospitalization. Therefore, PEID may be a promising alternative to traditional surgery.
PubMed: 35444463
DOI: 10.2147/JPR.S352595