-
The Journal of International Medical... Jan 2021Pediatric lumbar disc herniation (LDH), although uncommon, causes significant pain, discomfort, and sometimes disability. We examined the efficacy of percutaneous... (Review)
Review
Efficacy of percutaneous endoscopic lumbar discectomy for pediatric lumbar disc herniation and degeneration on magnetic resonance imaging: case series and literature review.
OBJECTIVE
Pediatric lumbar disc herniation (LDH), although uncommon, causes significant pain, discomfort, and sometimes disability. We examined the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for pediatric LDH and the degree of lumbar disc degeneration at 1 year after PELD.
METHODS
We retrospectively reviewed the data of pediatric patients with LDH who underwent PELD from December 2007 to July 2018. The patients' symptoms, physical examination findings, clinical images, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), and perioperative results (blood loss, length of hospital stay, and complications) were obtained from the medical records. Lumbar disc degeneration was graded using the modified Pfirrmann grading system at the 1-year postoperative magnetic resonance imaging (MRI) examination.
RESULTS
Six boys and four girls who underwent PELD were evaluated. The patients' mean age was 15.6 years (range, 13-17 years). The mean VAS score for low back pain, mean VAS score for lower limb pain, and mean ODI preoperatively and 1 year postoperatively were 6.2 and 0.3, 6.9 and 0.5, and 20 and 0.1, respectively. MRI showed significant disc degeneration after PELD.
CONCLUSIONS
Treating pediatric LDH with PELD is safe and effective. It relieves pain and reduces disability. However, lumbar disc degeneration still occurs.
Topics: Adolescent; Child; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Retrospective Studies; Treatment Outcome
PubMed: 33472475
DOI: 10.1177/0300060520986685 -
Orthopaedic Surgery Aug 2020To compare the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) for posterior ring apophyseal fractures... (Comparative Study)
Comparative Study
OBJECTIVE
To compare the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) for posterior ring apophyseal fractures (PRAF).
METHODS
This study was a retrospective cohort control study. A total of 96 patients with lumbar PRAF who underwent surgical treatment at the Henan Provincial People's Hospital of Henan University from September 2013 to December 2017 were retrospectively examined, of which 51 were treated by PTED and 45 by FD. The average age of those in the PTED group was 28.24 years, including 38 males and 13 females. The average age of those in the FD group was 28.07 years, with 33 males and 12 females. Operation time, total blood loss, hospitalization days, preoperative and postoperative visual analog scale (VAS), and Oswestry disability index (ODI) scores were evaluated. Modified MacNab criteria were used to evaluate the clinical effect at the last follow-up.
RESULTS
Both operations were successful and no serious complications occurred. All patients were followed up for 12-30 (average 16.7 ± 3.2) months, and no patients were lost to follow-up. No statistically significant difference was found in the mean age and gender between the PTED group and the FD group (P < 0.05). Operation time, total blood loss, and length of hospital stay were significantly lower in the PTED group (87.65 ± 13.15 min, 12.78 ± 4.95 mL, and 6.80 ± 1.67 days, respectively) than in the FD group (114.11 ± 14.39 min, 30.89 ± 7.09 mL, and 11.71 ± 1.98 days, respectively) (P < 0.05). The VAS and ODI scores of the two groups at postoperative day 1 (PTED: 3.82 ± 0.97, 37.73% ± 3.72%; FD: 3.62 ± 1.09, 36.62% ± 3.05%), and at 3 months (PTED: 2.90 ± 1.08, 26.02% ± 2.90%; FD: 3.07 ± 0.99, 27.16% ± 4.02%), 6 months (PTED: 2.31 ± 0.88, 22.53% ± 2.67%; FD: 2.36 ± 0.77, 21.18% ± 3.35%), and the last follow-up (PTED: 1.90 ± 0.83, 19.88% ± 3.01%; FD: 1.89 ± 0.86, 18.22% ± 3.03%) were significantly different from the preoperative scores (PTED: 6.53 ± 1.00, 55.24% ± 4.54%; FD: 6.78 ± 1.31, 53.56% ± 5.73%) (P < 0.05). The VAS and ODI scores at 3 months postoperatively, 6 months postoperatively, and the last follow up were not significantly different between the two groups (P > 0.05). In the PTED group, 2 patients developed a transient nerve stimulation symptom within 1 day after surgery and 1 patient had recurrence at 3 months after surgery. In the FD group, 2 patients had severe dural ruptures due to adhesion during surgery, 1 patient developed infection complications, and 2 patients relapsed at 2 and 3 months after surgery. At the last follow-up, the modified MacNab criteria for clinical effect were 93.3% and 94.1% in the FD and PTED groups, respectively.
CONCLUSION
While PTED has the same efficacy as FD for treating PRAF, it is associated with shorter operation time, less trauma, and quicker recovery.
Topics: Adult; Cohort Studies; Disability Evaluation; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Pain Measurement; Retrospective Studies; Spinal Fractures
PubMed: 32583556
DOI: 10.1111/os.12698 -
Revista Brasileira de Ortopedia Feb 2020To evaluate the clinical and functional results of transforaminal endoscopic lumbar discectomy. From August 2015 to January 2017, 101 patients with lumbar disc...
To evaluate the clinical and functional results of transforaminal endoscopic lumbar discectomy. From August 2015 to January 2017, 101 patients with lumbar disc hernia refractory to clinical treatment underwent endoscopic discectomy. Through clinical evaluation by the Visual Analogue Scale and functional evaluation by the Oswestry Disability Index questionnaire, the patients were analyzed in the preoperative period, the immediate postoperative period, at 1 month, 3 months, 6 months and 1 year after surgery. The mean age of the participants was 48.1 years. The most affected disc levels were L4-L5 and L5-S1. A total of 29 patients were treated at 2 disc levels. After 1 month of postoperative follow-up, the mean scores on the questionnaires (VAS and ODI) decreased significantly ( < 0.001). Transforaminal endoscopic Lumbar discectomy has been shown to be a safe, effective and minimally-invasive alternative for the treatment of lumbar disc herniation. The procedure has advantages, such as short hospital stay, surgery performed under local anesthesia and sedation, early return to daily activities, and low rate of complications.
PubMed: 32123445
DOI: 10.1055/s-0039-1700822 -
International Journal of Surgery... Jul 2016The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for the treatment of lumbar disc herniation (LDH).
METHODS
Randomized controlled trials or non-randomized controlled trials published from the time when databases were built to March 2016 that compared the clinical effectiveness of PELD and OLM surgical approaches for the treatment of LDH were acquired by a comprehensive search in four electronic databases (PubMed, EMBASE, Web of Science and Cochrane library). A total of 7 studies (1389 patients) were included in this systematic review and meta-analysis. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes.
RESULT
The results showed that there were no statistically between the PELD group and OLM group in terms of preoperative VAS-BP score (WMD = 0.03; 95% CI: -0.99 to 1.05; P = 0.95), postoperative VAS-BP score (WMD = -0.56; 95% CI: -1.43 to 0.31; P = 0.21), postoperative ODI (WMD = -0.98; 95% CI: -4.96 to 3.00; P = 0.63), complication rate (OR = 1.79; 95% CI: 0.95 to 3.37; P = 0.07) or reoperation rate (OR = 1.44; 95% CI: 0.94 to 2.20; P = 0.09). PELD group was associated with shorter operation time (WMD = -12.83; 95% CI: -24.79 to -0.87; P = 0.04) and hospital stay (WMD = -5.49; 95% CI: -8.63 to -2.35; P = 0.0006).
CONCLUSION
The existing evidence indicate that no superiority exists between the two surgical approaches for the treatment of LDH in terms of functional outcome, complication rate and reoperation rate, in spite of that PELD surgical group can achieve shorter operation time and hospital stay than OLM surgical group.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Treatment Outcome
PubMed: 27260312
DOI: 10.1016/j.ijsu.2016.05.061 -
Journal of Orthopaedic Surgery and... Aug 2023This study aimed to evaluate the clinical efficacy and safety of percutaneous endoscopic interlaminar discectomy (PEID) for treating highly downward-migrated disc...
OBJECTIVES
This study aimed to evaluate the clinical efficacy and safety of percutaneous endoscopic interlaminar discectomy (PEID) for treating highly downward-migrated disc herniation.
METHODS
We conducted a retrospective study on 39 patients with highly downward-migrated disc herniation who underwent PEID treatment between January 2015 and October 2020. The clinical outcomes, including the preoperative and postoperative visual analogue scale (VAS) for the back and leg, Oswestry Disability Index (ODI), and MacNab criteria for surgical success, were evaluated and compared to thirty-seven patients treated with posterior lumbar interbody fusion (PLIF).
RESULTS
The mean operation time of PEID was 93.00(77.00,110.00) min, while that of PLIF was 169.00(157.00,183.00) min. Continued improvement in both PEID and PLIF was observed in the VAS and ODI scores immediately after the surgery to the last follow-up. The VAS and ODI scores of PEID one week after surgery were significantly different from those of PLIF. One patient with recurrent lumbar disc herniation in the same segment improved after undergoing repeat PEID, two patients had dura tears, and conservative treatment helped relieve the symptoms. The overall percentage of patients with good to excellent results of PELD according to the modified MacNab criteria was 97.43%, while that of PLIF was 94.60%.
CONCLUSIONS
PEID has reliable efficacy and safety for treating highly downward-migrated disc herniation. And the long-term efficacy of PEID is comparable to PLIF. No severe complications occurred after surgery, and most patients' symptoms were relieved.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Lumbar Vertebrae; Diskectomy, Percutaneous; Endoscopy; Diskectomy; Treatment Outcome
PubMed: 37580753
DOI: 10.1186/s13018-023-04090-z -
Pain Physician Nov 2023Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery... (Clinical Trial)
Clinical Trial
Comparison of Percutaneous Endoscopic Transforaminal and Interlaminar Approaches in Treating Adjacent Segment Disease Following Lumbar Decompression Surgery: A Clinical Retrospective Study.
BACKGROUND
Adjacent segment disease (ASD) is a common complication following posterior disc decompression and fusion surgery. Percutaneous endoscopic lumbar decompression surgery (PELD) has been used to treat ASD through either a transforaminal or interlaminar approach. However, to our limited knowledge there are no reports comparing the 2 approaches for treating ASD.
OBJECTIVE
To evaluate clinical outcomes of PELD in treating ASD and comparing the surgical results and complications between the 2 approaches. This may be helpful for spinal surgeons when decision-making ASD treatment.
STUDY DESIGN
A clinical retrospective study.
SETTING
This study was conducted at the Department of Orthopedics of the Affiliated Hospital of Qingdao University.
METHODS
From January 2015 through December 2019, a total of 68 patients with ASD who underwent PELD after lumbar posterior decompression with fusion surgery were included in this study. The patients were divided into a percutaneous endoscopic transforaminal decompression (PETD) group and a percutaneous endoscopic interlaminar decompression (PEID) group according to the approach used. The demographic characteristics, radiographic and clinical outcomes, and complications were recorded in both groups through a chart review.
RESULTS
Of the 68 patients, 40 underwent PEID and 28 patients underwent PETD. Compared with their preoperative Visual Analog Scale (VAS) pain score and Oswestry Disability Index (ODI) score, all patients had significant postoperative improvement at 3 months, 6 months, one year and at the latest follow-up. There were no significant statistical differences in the VAS and ODI scores between PETD and PEID groups with a P value > 0.05. There was a significant statistical difference in the average fluoroscopy times between the PETD and PEID groups with a P value = 0.000. Revision surgery occurred in 8 patients: 6 patients who underwent PETD and 2 patients who underwent PEID. The revision rate showed a significant statistical difference between the 2 approaches with a P value = 0.039.
LIMITATIONS
Firstly, the number of patients included in this study was small. More patients are needed in a further study. Secondly, the follow-up time was limited in this study. There is still no conclusion about whether the primary decompression with instruments will increase the reoperation rate after a PELD, and a longer follow-up is needed in the future. Thirdly, this study was a clinical retrospective study. Randomized or controlled trials are needed in the future in order to achieve a higher level of evidence. Fourthly, there were debates about PELD approach choices for ASDs, which may affect the comparison results between PETD and PEID. In our study, the approaches were mainly determined by the level and types of disc herniation, and the surgeons' preference. More patients with an ASD with different levels and types of disc herniation and surgical approaches are needed in the future to eliminate these biases.
CONCLUSION
Percutaneous endoscopic lumbar decompression surgery is a feasible option for ASD following lumbar decompression surgery with instruments. Compared with PETD, PEID seems to be a better approach to treat symptomatic ASDs.
Topics: Humans; Decompression; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 37976490
DOI: No ID Found -
Medical Science Monitor : International... Aug 2023BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has gained popularity as a minimally invasive surgery for treating lumbar disc herniation. However, there is...
Risk Factors and Causes of Reoperation in Lumbar Disc Herniation Patients after Percutaneous Endoscopic Lumbar Discectomy: A Retrospective Case Series with a Minimum 2-Year Follow-Up.
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has gained popularity as a minimally invasive surgery for treating lumbar disc herniation. However, there is limited research focusing on the reoperation rate and its associated factors. This study aims to investigate the rate of reoperation and identify the causes and risk factors for reoperation after PELD. MATERIAL AND METHODS We conducted a retrospective analysis of patients who underwent PELD (interlaminar and transforaminal approaches) at our hospital from November 2016 to May 2020. A matched case-control design was employed to identify relevant risk factors for reoperation, with a matching ratio of 1:3. Clinical characteristics and radiological parameters were compared, and univariate analysis was performed using independent samples t-test and chi-squared test. RESULTS Among the 435 patients included in the study, the reoperation rate for those with a minimum 2-year follow-up was 6.2% (27/435). The causes of reoperation and their respective rates were as follows: recurrence of lumbar disc herniation (3.2%, 14/435), incomplete decompression (1.8%, 8/435), persistent low back pain (0.7%, 3/435), and postoperative infection (0.5%, 2/435). Univariate analysis revealed that age (P=0.015), Pfirrmann grade IV-V (P=0.017), and lack of active straight leg raise exercises (P=0.026) were significantly associated with reoperation. Multiple logistic regression analysis indicated that age (P=0.001), Pfirrmann grade IV-V (P=0.033), and lack of active straight leg raise exercises postoperatively (P=0.003) were independent risk factors for reoperation after PELD. CONCLUSIONS The primary cause of reoperation in lumbar disc herniation patients after PELD was recurrence of the herniation. Additionally, severe disc degeneration, older age, and lack of active straight leg raise exercises were identified as significant risk factors associated with an increased reoperation rate.
Topics: Humans; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Retrospective Studies; Reoperation; Follow-Up Studies; Lumbar Vertebrae; Diskectomy; Endoscopy; Risk Factors; Research Design; Treatment Outcome
PubMed: 37580900
DOI: 10.12659/MSM.939844 -
Journal of Orthopaedic Surgery and... Dec 2023Although spinal endoscopic techniques have shown great advantages in the treatment of single-segment lumbar disk herniation (LDH), the therapeutic advantages for...
OBJECTIVE
Although spinal endoscopic techniques have shown great advantages in the treatment of single-segment lumbar disk herniation (LDH), the therapeutic advantages for double-segment LDH are controversial. To compare the outcomes of percutaneous endoscopic interlaminar discectomy (PEID) versus conventional open lumbar discectomy (COLD) for the treatment of L4/5 and L5/S1 double-segmental LDH.
METHODS
From January 2016 to September 2021, we included 50 patients with double-segmental LDH who underwent PEID (n = 25) or COLD (n = 25). The clinical outcomes between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified MacNab criteria. Moreover, the incision length, operation time, intraoperative fluoroscopy time, postoperative bedtime, hospital stays, and complications were also recorded and compared after surgery.
RESULTS
In both groups, the VAS and ODI scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05) According to the modified MacNab criteria, the excellent or good outcome rate was 92% in the PEID group and 88% in the COLD group. The PEID group had shorter incision length, postoperative bedtime, and hospital stays than the COLD group. However, the operation time was shorter and intraoperative fluoroscopy time was fewer in the COLD group. In addition, there was no significant difference between the two groups in terms of surgical complications during the postoperative follow-up period.
CONCLUSIONS
Both PEID and COLD have good efficacy and high safety for management of L4/5 and L5/S1 double-segmental LDH. Compared with the COLD group, the PEID group had more operative time as well as more intraoperative fluoroscopy, but it had a more minimally invasive surgical incision as well as faster postoperative recovery.
Topics: Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Endoscopy; Diskectomy, Percutaneous; Diskectomy; Treatment Outcome
PubMed: 38082370
DOI: 10.1186/s13018-023-04361-9 -
World Journal of Orthopedics Dec 2017Transforaminal Percutaneous Endoscopic Discectomy (TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral... (Review)
Review
Transforaminal Percutaneous Endoscopic Discectomy (TPED) is a minimally invasive technique mainly used for the treatment of lumbar disc herniation from a lateral approach. Performed under local anesthesia, TPED has been proven to be a safe and effective technique which has been also associated with shorter rehabilitation period, reduced blood loss, trauma, and scar tissue compared to conventional procedures. However, the procedure should be performed by a spine surgeon experienced in the specific technique and capable of recognizing or avoiding various challenging conditions. In this review, pitfalls that a novice surgeon has to be mindful of, are reported and analyzed.
PubMed: 29312845
DOI: 10.5312/wjo.v8.i12.874 -
Pain Physician Nov 2022Postoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and... (Observational Study)
Observational Study
BACKGROUND
Postoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPCED) has not yet been reported.
OBJECTIVE
To introduce cases of postoperative ULP after PPCED and associated risk factors.
STUDY DESIGN
A single-center, retrospective, observational study.
SETTING
Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
METHODS
From January 2016 through January 2022, PPCED involving a total of 663 segments was performed in 610 patients with radiculopathy who were diagnosed with cervical radiculopathy or mixed cervical spondylosis caused by foraminal stenosis or posterolateral disc herniation.
RESULTS
PPCED was successfully completed in 610 patients, 6 of whom (0.98%) developed ULP. Two patients were diagnosed with double-segment cervical nerve root canal stenosis (C4/5/6, C5/6/7) and 2 with migrated cervical disc soft herniation (a magnetic resonance image of one showed a migrated disc herniation downward from C4/5 in the sagittal plane; another showed this upward from C5/6); one patient was diagnosed with C5/6 intervertebral foraminal stenosis, and one had simple C4/5 lateral disc herniation. Postoperative ULP rates for C4/5 (2/30, 6.67%) and C5/6 (2/177, 1.13%) were much higher than those for the other levels. Anatomically, the width of the intervertebral foramen on computed tomography was 2.3 ± 1.12 mm in ULP cases, which was significantly lower than that in non-ULP cases (3.4 ± 1.83, P < 0.05). This suggests that preoperative foramen width correlates highly negatively with postoperative ULP incidence.
LIMITATIONS
This was a single-center, retrospective, nonrandomized study with a low level of evidence.
CONCLUSIONS
PPCED is a good treatment for cervical radiculopathy. The rate of postoperative ULP after PPCED is much lower than that after posterior cervical foraminotomy. Perturbation to the C5 (or C6) nerve root, thermal injury due to burr use or the radiofrequency applied, and marked foraminal stenosis are possible relevant factors associated with postoperative ULP.
Topics: Humans; Foraminotomy; Intervertebral Disc Displacement; Radiculopathy; Constriction, Pathologic; Retrospective Studies; Cervical Vertebrae; China; Diskectomy; Paralysis; Upper Extremity; Treatment Outcome
PubMed: 36375202
DOI: No ID Found