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Scientific Reports Aug 2022Percutaneous laser discectomy is one common and effective treatment for cervical radicular pain. Currently, the surgery is performed with blind cannulation technique,...
Percutaneous laser discectomy is one common and effective treatment for cervical radicular pain. Currently, the surgery is performed with blind cannulation technique, mainly relies on the experience of surgeon. However, it still remains unsafe and difficult to reach the target. As an alternative, ultrasound-guided cannulation provides visualization of important structures, thus increasing the precision and safety. The primary goal of this study is to report the detail of the ultrasound-guided technique in the percutaneous laser cervical discectomy. The secondary purpose is to evaluate the feasibility of the novel therapy. This is a single center, feasibility study conducted in one teaching hospital. Thirteen intervertebral discs in 9 patients presented with cervical radicular pain. Accuracy of the cannulation with ultrasonic guidance was confirmed by the anterior-posterior and lateral view of fluoroscopy. We compared the pain severity pre- and post-treatment with Visual Analogue Score (VAS), and functional improvement was assessed with the modified Macnab Criteria and Neck Disability Index (NDI) respectively. Ultrasonic short-axis was used to scan the cervical nerve root, and its transition was used to identify the distinct intervertebral space. Following the recognition of targeted cervical level, the ultrasound probe was moved medially for the visualization of the surface of the cervical vertebrae. In plane cannulation was then applied to avoid the injury of the vessels. The location of cannula was confirmed by the fluoroscopic imaging. Low-power laser was set for the cervical disc ablation in this cohort. The majority of the surgical sites maintained in the C5/6 level (38%), and 31% for the C6/7 level respectively. Despite the distinct cervical level, the tip of needle was properly placed near by the targeted intervertebral disc in all participants, which was confirmed by the imaging of fluoroscopy. We did not observe any obvious complications during the procedure. The mean VAS decreased from 7.6 ± 1.1 to 2.3 ± 2.7 one month after discharge, and 2.1 ± 2.6 at the last follow-up (median duration of nine months). All patients reported significant improvement of NDI up to last follow-up (p = 0.011). Meanwhile, the good to excellent rate was reported in 8 of 9 patients (89%) according to the modified Macnab Criteria. The finding of this feasibility assessment indicates the ultrasound-based cannulation technique is capable of guiding the cannulation for the percutaneous laser discectomy. It may facilitate identifying the corresponding site of cervical intervertebral disc and prevent the damage of vessel.
Topics: Cervical Vertebrae; Diskectomy; Feasibility Studies; Humans; Intervertebral Disc Displacement; Lasers; Neck Pain; Radiculopathy; Retrospective Studies; Treatment Outcome; Ultrasonography, Interventional
PubMed: 35918378
DOI: 10.1038/s41598-022-17627-9 -
American Journal of Translational... 2021The present study aimed to investigate the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) in the...
BACKGROUND
The present study aimed to investigate the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) in the treatment of upper lumbar disc herniation (ULDH).
METHODS
A total of 62 ULDH patients treated with PTED or MED were enrolled in this study and were randomly divided into group A (PTED, n=31) and group B (MED, n=31). The characteristics, surgical duration, incision length, blood loss, volume of drainage, length of hospital stay, and the complications and recurrences of patients were recorded and compared between the two groups. The Japanese Orthopedic Association (JOA), Oswestry Disability Index (ODI), and visual analogue scale (VAS) scores were compared preoperatively, postoperatively, and at the final follow-up between group A and group B. The postoperatively clinical outcomes of patients were evaluated according to the modified MacNab criterion.
RESULTS
The incision length, the duration of surgery, intraoperative blood loss, volume of drainage, and length of hospital stay in group A were less than those in group B (<0.01). Compared with group B, the JOA scores of the patients in group A were significantly enhanced at 1 month (<0.01), 3 months (<0.01), and 6 months (<0.01), the VAS scores were significantly improved at 1 month (<0.01), 3 months (<0.01), 6 months (<0.05), and 12 months (<0.05), and the ODI scores exhibited significant improvements at 1 month (<0.01) and 3 months (<0.05).
CONCLUSION
PTED provides better results in the treatment of ULDH compared with MED. It is beneficial to improve the quality of life of patients and is worthy of promotion in clinical application.
PubMed: 34017479
DOI: No ID Found -
Pain Physician Mar 2018Percutaneous endoscopic discectomy (PED) includes 2 main procedures: percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy...
BACKGROUND
Percutaneous endoscopic discectomy (PED) includes 2 main procedures: percutaneous endoscopic lumbar discectomy (PELD) and percutaneous endoscopic interlaminar discectomy (PEID), both of which are minimally invasive surgical procedures that effectively deal with lumbar degenerative disorders. Because of the challenging learning curve for the surgeon and the individual characteristics of each patient, preventing and avoiding complications is difficult. The most common complications, such as nucleus pulposus omission, nerve root injury, dural tear, visceral injury, nerve root induced hyperalgesia or burning-like nerve root pain, postoperative dysesthesia, posterior neck pain, and surgical site infection, are difficult to avoid; however, more focus on these issues perioperatively may be in order. Additionally, unique and unexpected complications can also occur, such as retroperitoneal hematoma (RPH), intraoperative seizures, and thrombophlebitis, among others.
OBJECTIVE
We aim to delineate unique complications during PED and accumulate strategies to prevent significant morbidity and improve surgical techniques.
STUDY DESIGN
A retrospective cohort study of patients undergoing PEID or PELD from October 2014 to January 2016.
SETTING
Affiliated hospitals of Qingdao University.
METHODS
Patients with lumbar disc herniation (LDH) who underwent PEID and PELD were retrospectively analyzed. Complications were recorded and analyzed pre and postoperatively. We assessed clinical outcomes using the visual analog scale (VAS) and Oswestry Disability Index (ODI) and classified the results into "excellent," "good," "fair," or "poor" based on the modified MacNab criteria. All of the patients were followed for more than one year to evaluate their recovery from complications.
RESULTS
From October 2014 to January 2016, 426 patients with LDH underwent PEID (106 cases) or PELD (320 cases). Common complications and occurrence rates were as follows: the incomplete removal of herniated discs was 1.4% (6/426), recurrence 2.8% (12/426), nerve root injury 1.2% (5/426), dural tear 0.9% (4/426), and nerve root induced hyperalgesia or burning-like nerve root pain 2.3% (10/426); no posterior neck pain or surgical site infection occurred. Unique complications included: passage of the working channel through the spinal canal into the disc space (one case), super-elastic nerve hook caught by exiting nerve root (one case), epidural hematoma (one case), radicular artery injury and massive bleeding (one case) which was revised by micro-endoscopic discectomy, and intraoperative seizure (one case). No serious consequences occurred after active medical intervention, and most patients had good recovery by 3 months postoperatively with physical therapy.
LIMITATIONS
The main limitations of this study are the retrospective study design, limited case number, and short follow-up period.
CONCLUSIONS
PEDs are effective and minimally invasive methods for the surgical treatment of LDH, causing fewer complications due to the very minimal operational trauma for the muscle-ligament complex and stability of the spine. Nevertheless, because of the difficult learning curve for surgeons, lack of experience with the requisite surgical techniques, and enhanced clinical responsibility, a variety of problems may occur. Especially concerning are the unique complications mentioned here, which potentially lead to severe injury for the patient and require diligent preventive measures.
KEY WORDS
Unique complications, epidural, hematoma, interlaminar, transforaminal, PEID, PELD.
Topics: Adult; Aged; Cohort Studies; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Minimally Invasive Surgical Procedures; Retrospective Studies
PubMed: 29565953
DOI: No ID Found -
Pain Physician Jan 2021Percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) are alternative minimally invasive procedures for the treatment of... (Comparative Study)
Comparative Study
Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microendoscopic Discectomy for the Surgical Management of Symptomatic Lumbar Disc Herniation: A Multicenter Retrospective Cohort Study with a Minimum of 2 Years' Follow-Up.
BACKGROUND
Percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) are alternative minimally invasive procedures for the treatment of symptomatic lumbar disc herniation (LDH). However, insufficient literature exists to highlight the differences between the procedures.
OBJECTIVES
This study intended to clarify whether PTED results in better clinical outcomes compared with MED in the surgical management of single-level LDH.
STUDY DESIGN
A multicenter retrospective cohort study.
SETTING
This study took place in 2 spinal minimally invasive centers in Beijing, China.
METHODS
A multicenter retrospective study was conducted in consecutive patients diagnosed with symptomatic LDH receiving PTED or MED in 2 spinal minimally invasive centers from April 2009 to July 2016. A total of 1,053 patients were recruited, of which 632 underwent PTED and 421 underwent MED. All patients were followed with a minimum of 2 years; a set of clinical outcomes were extracted and analyzed.
RESULTS
The operation time was similar between groups (71.2 ± 15.1 minutes in the PTED group and 69.4 ± 12.5 minutes in the MED group; P = 0.518); length of incision was significantly shorter; intraoperative blood loss was less in the PTED group (P < 0.001); hospital stay was 3.6 ± 1.5 days in the PTED group and 5.4 ± 2.8 days in the MED group with significant differences detected (P = 0.018); however, intraoperative fluoroscopy was longer with significantly higher cost with the PTED group (P < 0.001). Transient dysesthesia and wound complications were more common in the MED group (P = 0.039 and P = 0.026, respectively); however, no significant differences were found with total complications (P = 0.139). Significant lower Visual Analog Scale pain score (back and leg) were detected on day 1 postoperatively (P = 0.007 and P = 0.018, respectively). No significant differences were found at all other time points (P > 0.05). Significantly better Oswestry Disability Index (ODI) score was detected postoperatively at 1 month in the PTED group (19.6 ± 9.8 vs. 27.2 ± 9.3; P = 0.016); ODI score at other time points did not differ significantly between groups (P > 0.05). Modified MacNab criteria showed that most patients experienced excellent and good results with no significant differences between groups (P = 0.511).
LIMITATION
This was a multicenter retrospective study wherein the surgeons may have introduced bias to the study.
CONCLUSIONS
Both PTED and MED present to be an acceptable long-term efficacy for the treatment of LDH. Although PTED is associated with longer intraoperative fluoroscopy and a little more cost, it should still be considered superior to MED considering the benefits of lesser invasion, shorter hospital stays, quicker pain relief, and functional recovery.
Topics: Aged; China; Cohort Studies; Diskectomy, Percutaneous; Endoscopy; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Minimally Invasive Surgical Procedures; Retrospective Studies
PubMed: 33400445
DOI: No ID Found -
BMC Musculoskeletal Disorders Dec 2021With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective...
BACKGROUND
With the advancements in surgical methods, optical designs, and surgical instruments, percutaneous endoscopic transforaminal discectomy (PETD) has become an effective and minimally invasive procedure to treat lumbar spinal stenosis (LSS) in recent years. Few studies have focused on the complications associated with the treatment of LSS using percutaneous endoscopic lumbar discectomy (PELD). This study aimed to summarize the complications of PETD and identify the associated risk factors.
METHODS
Complications in a total of 738 consecutive LSS patients who underwent single-level PETD were retrospectively recorded and analyzed between January 2016 and July 2020. In addition, a matched case-control study was designed, and according to the date of operation, the control group was matched with patients without complications, with a matching ratio of 1:3. Demographic parameters included age, sex, BMI, smoking and drinking status, comorbidity, and surgical level. The radiological parameters included grade of surgical-level disc degeneration, number of degenerative lumbar discs, grade of lumbar spinal stenosis, degenerative lumbar scoliosis, lumbar lordosis, disc angle, and disc height index. Univariate analysis was performed using independent samples t-test and chi-squared test.
RESULTS
The incidence of different types of complications was 9.76% (72/738). The complications and occurrence rates were as follows: recurrence of LSS (rLSS), 2.30% (17/738); persistent lumbosacral or lower extremity pain, 3.79% (28/738); dural tear, 1.90% (14/738); incomplete decompression, 0.81% (6/738); surgical site infection, 0.41% (3/738); epidural hematoma, 0.27% (2/738); and intraoperative posterior neck pain, 0.27% (2/738). Univariate analysis demonstrated that age, the grade of surgical-level disc degeneration (P < 0.001) and the number of disc degeneration levels (P = 0.004) were significantly related to the complications.
CONCLUSION
Complications in the treatment of LSS using PELD included rLSS, persistent pain of the lumbosacral or lower extremity, dural tear, incomplete decompression, surgical site infection, epidural hematoma, and intraoperative posterior neck pain. In addition, old age, severe grade of surgical-level disc degeneration and more disc degeneration levels significantly increased the incidence of complications.
Topics: Case-Control Studies; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Risk Factors; Spinal Stenosis; Treatment Outcome
PubMed: 34911532
DOI: 10.1186/s12891-021-04940-z -
Journal of Orthopaedic Surgery and... Jul 2022To evaluate the efficacy and feasibility of percutaneous endoscopic interlaminar discectomy (PEID) via the inner border of the inferior pedicle approach for downmigrated... (Review)
Review
OBJECTIVE
To evaluate the efficacy and feasibility of percutaneous endoscopic interlaminar discectomy (PEID) via the inner border of the inferior pedicle approach for downmigrated disc herniation.
METHODS
Seventeen patients who had downmigrated disc herniation were included in this study from May 2020 to February 2021. After PEID via the inner border of the inferior pedicle approach, a retrospective study was conducted on all patients. Radiologic findings were investigated, and based on the level of migration seen on preoperative magnetic resonance imaging (MRI), participants were divided into two types (high-grade and low-grade migrations). Preoperative, 1st post-operative day, 3rd post-operative month, and the final follow-up visual analogue scale (VAS) assessments for back and leg pain and preoperative, 3rd post-operative month, and the final follow-up Oswestry disability index (ODI) evaluations were performed. The clinical effects at the final follow-up were assessed by the modified MacNab criterion.
RESULTS
All patients successfully completed surgery. There were 10 males and 7 females in the group. These patients were 42 years old on average (range, 25-68 years). Four and 13 patients had downmigrated disc herniation with high-grade and low-grade, respectively, on MRI. The mean follow-up duration was 10.47 ± 1.84 months (range, 8-14 months). The mean VAS score for back and leg improved from 5.18 ± 0.81 preoperatively to 1.35 ± 0.49 at the final follow-up (P < 0.05) and 6.94 ± 0.66 preoperatively to 1.47 ± 0.51 at the final follow-up (P < 0.05), respectively. The mean ODI score improved from 48.00 ± 3.64 preoperatively to 18.71 ± 1.31 at the final follow-up (P < 0.05). According to the modified MacNab criterion, 15 patients (88.2%) obtained excellent, while the rest 2 patients (11.8%) reported good outcomes.
CONCLUSION
PEID via the inner border of the inferior pedicle approach could be a good alternative option for the treatment of downmigrated disc herniation.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Retrospective Studies; Treatment Outcome
PubMed: 35864515
DOI: 10.1186/s13018-022-03245-8 -
World Neurosurgery Apr 2023To develop and validate a nomogram for predicting recurrent lumbar disk herniation (LDH) within 2 years after percutaneous endoscopic lumbar discectomy.
OBJECTIVE
To develop and validate a nomogram for predicting recurrent lumbar disk herniation (LDH) within 2 years after percutaneous endoscopic lumbar discectomy.
METHODS
Information on patients' LDH was collected from 1 medical center between January 2015 and September 2020. The LASSO (least absolute shrinkage and selection operator) method was applied to select the most significant risk factors. A multivariate logistic regression analysis was used to develop a predictive model incorporating the possible factors selected by the LASSO regression model. The discriminant, corrected, and clinically useful prediction models were evaluated using consistency index (C-index), receiver operating characteristic curve, calibration curves, and decision curve analysis. Internal validation of clinical predictive power was also assessed by bootstrap validation.
RESULTS
A total of 690 patients with LDH were included in this study. Sixty-three patients experienced recurrence within 2 years whereas 627 experienced no recurrence. The nomogram predictors included age, body mass index, Modic change, Pfirrmann grade, and sagittal range of motion. The model had good discrimination power, with a reliable C-index of 0.868 (95% confidence interval, 0.822-0.913) and interval validation confirmed a higher C-index value of 0.846. The area under the receiver operating characteristic curve was 0.868, indicating a good predictive value. The decision curve analysis indicated that it was clinically feasible to use the predictive recurrence nomogram model.
CONCLUSIONS
We developed and validated a new accurate and effective nomogram for predicting recurrent LDH within 2 years after percutaneous endoscopic lumbar discectomy. Age, body mass index, Modic change, Pfirrmann grade, and sagittal range of motion were significant features for predicting rLDH.
Topics: Humans; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Nomograms; Lumbar Vertebrae; Diskectomy
PubMed: 36640832
DOI: 10.1016/j.wneu.2023.01.026 -
BMC Musculoskeletal Disorders Jun 2024Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of... (Comparative Study)
Comparative Study
BACKGROUND
Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of patients with ULDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) compared with those with lower LDH.
METHODS
60 patients with ULDH or L4-L5 LDH treated with PTED between May 2016 and October 2021. MacNab criteria, visual analog scale (VAS) of back pain and leg pain, and Japanese Orthopedic Association (JOA) were evaluated before and after surgery.
RESULTS
In the L1-L3 group, 59.1% of the patients had a positive femoral nerve tension test, and 81.8% of the patients had a sensory deficit. Both groups showed significant improvements in VAS scores for low back and leg pain, and JOA scores postoperatively. No significant differences in the degree of improvement were observed between the two groups. The excellent/good rate was 81.8% in the L1-L3 group and 84.2% in the L4-L5 group, showing no significant difference.
CONCLUSION
PTED has comparable efficacy in treating ULDH as it does in treating lower LDH, it is a safe and effective treatment method for ULDH.
Topics: Humans; Intervertebral Disc Displacement; Male; Diskectomy, Percutaneous; Female; Lumbar Vertebrae; Middle Aged; Adult; Treatment Outcome; Endoscopy; Retrospective Studies; Pain Measurement; Aged
PubMed: 38879478
DOI: 10.1186/s12891-024-07588-7 -
Pain Physician Jul 2020Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc...
BACKGROUND
Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
OBJECTIVES
We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
STUDY DESIGN
This study used a retrospective design.
SETTING
Research was conducted in a hospital and outpatient surgical center.
METHODS
This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data.
RESULTS
Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD.
LIMITATIONS
The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection.
CONCLUSIONS
In patients with spondylolisthesis who have a herniated lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011.
KEY WORDS
Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic lumbar discectomy, retrospondylolisthesis, slippage.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Retrospective Studies; Spondylolisthesis; Treatment Outcome; Young Adult
PubMed: 32709174
DOI: No ID Found -
Cirugia Y Cirujanos 2023The aim of the study was to explore the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment...
BACKGROUND
The aim of the study was to explore the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH).
MATERIAL AND METHODS
The complete clinical data from 87 patients with LDH from our hospital were retrospectively analyzed. Patients were divided into a control group (n = 39, treated with FD) and a research group (n = 48, treated with PTED) according to the prescribed treatments. The basic operation conditions were compared across the two groups. Surgical outcomes were assessed. The incidences of complications and the life quality of patients were evaluated 1 year after surgery.
RESULTS
The patients in both groups completed the operation. The visual analog scale and Oswestry Disability Index score of patients in the research group was significantly lower while the Orthopaedic Association Score was significantly higher after surgery. The success rate of the operation in the research group which was significantly higher and the rate of complications was significantly lower. No statistical differences in the quality of life were observed between the patients (p > 0.05).
CONCLUSIONS
PTED and FD are effective in the treatment of LDH. However, our study showed that PTED has a higher rate of treatment success, faster recovery times and is safer than FD.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Quality of Life; Lumbar Vertebrae; Endoscopy; Diskectomy; Treatment Outcome
PubMed: 37084301
DOI: 10.24875/CIRU.21000774