-
Journal of Spine Surgery (Hong Kong) Sep 2016Percutaneous endoscopic lumbar discectomy (PELD) is one of the less invasive treatments for lumbar disc herniation (LDH), and has 3 different operative approaches. This...
BACKGROUND
Percutaneous endoscopic lumbar discectomy (PELD) is one of the less invasive treatments for lumbar disc herniation (LDH), and has 3 different operative approaches. This study focused on the posterolateral approach (PLA) and investigated the appropriate operative indication.
METHODS
PLA was performed in 29 patients with foraminal and extraforaminal LDH. The height and width of the foramen, LDH type, and positional relationship between LDH and the foramen were radiologically evaluated. Foraminoplasty was also performed in 12 cases including those combined with intra-canal LDH or osseous foraminal stenosis. Pre- and postoperative status was evaluated using Numerical Rating Scale (NRS) scores.
RESULTS
Patient mean age was 56.8 years; there was single-level involvement at L3/4 (13 cases) and at L4/5 (13 cases). The mean pre- and postoperative NRS scores were 6.1 and 1.8, respectively. Early recurrence developed in a patient who was found to have local scoliosis at the corresponding vertebral level.
CONCLUSIONS
PLA can be safely used to treat foraminal and extraforaminal LDH with foraminal height ≥13 mm and foraminal width ≥7 mm. The procedure is effective for preserving the facet joint; however, we should carefully consider the indications when local scoliosis and/or instability are present.
PubMed: 27757427
DOI: 10.21037/jss.2016.09.03 -
Orthopaedic Surgery Jul 2022To compare the effect of percutaneous endoscopic lumbar discectomy (PELD) using a double-cannula guide tube (DGT), traditional PELD, and open lumbar discectomy (OLD) to...
OBJECTIVE
To compare the effect of percutaneous endoscopic lumbar discectomy (PELD) using a double-cannula guide tube (DGT), traditional PELD, and open lumbar discectomy (OLD) to treat large lumbar disc herniations (LLDHs).
METHODS
Seventy patients who presented with LLDH without cauda equina syndrome and were treated with surgery in our hospital from October 2015 to October 2017 were included. The detailed index included the visual analog scale (VAS) for back and radicular leg pain and the Oswestry Disability Index (ODI) in the immediate preoperative period and at the final follow-up. The operation time, radiation exposure time, surgical satisfaction rate, and modified MacNab criteria score were also recorded.
RESULTS
The leg and back pain of the patients in these groups improved significantly in the postoperative period. No significant differences were observed in leg pain improvement between the other two groups; however, patients in the PELD group (with or without DGT) presented with significantly higher improvement in back pain than the OLD group (t = 9.965, p < 0.001). The final ODI scores were 12.1 ± 4.9, 11.2 ± 2.9, and 16.4 ± 3.6 in the PELD, PELD-DGT, and OLD groups, respectively. Patients in the PELD and PELD-DGT groups presented with significantly lower postoperative ODI scores than those in the OLD group (t = 20.834, p < 0.001). The mean postoperative hospital stays were significantly shorter in the PELD group and PELD with DGT group than in the OLD group (t = 46.688, p < 0.001). The mean operation time was significantly shorter in the PELD-DGT group than those in the PELD group (t = 25.281, p = 0.001). No perioperative complications were observed in either group. Based on the modified MacNab criteria, excellent and good outcomes were achieved in 20 out of 21 patients (95.2%) in the PELD group, 23 out of 24 patients (95.8%) in the PELD-DGT group, and 22 out of 25 patients (88.0%) in the OLD group. The rates of excellent and good outcomes were higher in the PELD and PELD-DGT groups than in the OLD group, but there were no significant differences (χ = 1.454, p = 0.835).
CONCLUSIONS
PELD using DGT is a safe and effective option for LLDH and features advantages such as improvements in back pain, a lower hospitalization cost than OLD, a shorter operation time, and less fluoroscopy than traditional PELD.
Topics: Cannula; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Pain; Retrospective Studies; Treatment Outcome
PubMed: 35656704
DOI: 10.1111/os.13313 -
Global Spine Journal Jul 2023Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVES
It remains unknown whether general anesthesia (GA) or local ± epidural anesthesia (LA) results in superior outcomes with percutaneous endoscopic lumbar discectomy (PELD). The present study sought to examine the impact of anesthesia type on patient-reported outcomes (PROs) and complications with PELD.
METHODS
Systematic review and meta-analysis examining PELD performed under GA or LA was conducted. Patient-reported outcomes including Visual Analog Scale (VAS)-leg/back, and Oswestry Disability Index (ODI) scores were collected. Complication, recurrent disc herniation, durotomy, and reoperation rates as well as surgical data were recorded. All outcomes were compared between pooled studies examining GA or LA.
RESULTS
Sixty-eight studies consisting of 5269 patients (724 GA, 4465 LA) were included in the meta-analysis. Overall complication rate was significantly higher in the GA group (9% vs 4%, = .003). Durotomy rates, length of stay, recurrent disc herniation and reoperation rates were similar between groups. At the first follow-up timepoint, the LA group demonstrated significant improvements in VAS back and ODI scores ( < .05) while the GA group did not ( > .05). At the final follow-up (> 6 months), the percent of patients achieving an excellent McNab score was significantly higher in the GA vs LA group ( < .001).
CONCLUSIONS
Percutaneous endoscopic lumbar discectomy with LA may be associated with greater short-term improvement in VAS back pain and ODI scores. General anesthesia may be associated with more durable pain relief but a higher complication rate. Further systematic investigation is necessary to determine what short and long term benefits are associated with PELD performed under LA and GA.
PubMed: 36564907
DOI: 10.1177/21925682221147868 -
Frontiers in Surgery 2022This study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery. (Review)
Review
BACKGROUND
This study aimed to evaluate the efficacy and safety of unilateral biportal endoscopy (UBE) versus other forms of spine surgery.
METHODS
Electronic databases were systematically searched up to February 2022. The authors used Review Manager 5.3 to manage the data and perform the review.
RESULTS
After the preliminary selection of 239 studies from electronic databases, the full inclusion criteria were applied; 16 studies were found to be eligible for inclusion. These 16 studies enrolled 1,488 patients: 653 patients in the UBE group, 570 in the microendoscopic discectomy group, 153 in the percutaneous endoscopic lumbar discectomy group, and 70 in the posterior lumbar interbody fusion group. UBE was superior to microendoscopic discectomy regarding 1-day Visual Analog Scale(VAS) back pain scores ( < 0.00001). No difference was found between UBE and microendoscopic discectomy regarding 1-day Visual Analog Scale leg pain scores ( = 0.25), long-term VAS back pain scores ( = 0.06), long-term VAS leg pain scores ( = 0.05), Oswestry Disability Index scores ( = 0.09) or complications ( = 0.19). Pooled analysis indicated that UBE was similar to percutaneous endoscopic lumbar discectomy regarding 1-day VAS back pain scores ( = 0.71), 1-day VAS leg pain scores ( = 0.37), long-term VAS back pain scores ( = 0.75), long-term VAS leg pain scores ( = 0.41), Oswestry Disability Index scores ( = 0.07) and complications ( = 0.88). One study reported no difference between UBE and posterior lumbar interbody fusion regarding long-term VAS back pain, long-term VAS leg pain, or Oswestry Disability Index scores.
CONCLUSIONS
UBE is superior to microendoscopic discectomy to relieve back pain 1 day postoperatively. However, these two procedures are similar regarding 1-day leg pain relief, long-term effects, and safety. UBE and percutaneous endoscopic lumbar discectomy are similar regarding 1-day pain relief, long-term effects and safety. More evidence is needed to evaluate the efficacy and safety of UBE versus posterior lumbar interbody fusion.
PubMed: 35959116
DOI: 10.3389/fsurg.2022.911914 -
Annals of Palliative Medicine Nov 2020The aim of the present study was to report a new technique for electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy and...
BACKGROUND
The aim of the present study was to report a new technique for electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy and to evaluate the efficacy of this technology in the treatment of lumbar disc herniation (LDH).
METHODS
This is a retrospective study. Seventeen patients who underwent electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy in our department from September to November 2018 were included in the study. Patients' hospital charts, magnetic resonance imaging results, surgical data and follow-up records were reviewed. Outcomes were assessed by visual analog scale (VAS) score, Oswestry Disability Index (ODI), modified MacNab criteria and postoperative complications.
RESULTS
The median follow-up time was 20.64 months (range, 19-21 months). The average operating time was 52.94±12.88 min (range, 35-78 min), including the working tube introduction time (13.59±2.89 min), decompression time (39.35±13.61 min), and the fluoroscopic time (3.65±2.52 min). Postoperative back VAS, leg VAS, and ODI were significantly improved compared with pre-operation, respectively (P<0.01). The overall excellent and good rate of these seventeen patients was 94%. There were no significant complications related to the operation.
CONCLUSIONS
Electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy is a safe and effective method for treating LDH and this method has the advantage of short operative time and fluoroscopic times.
Topics: Diskectomy; Diskectomy, Percutaneous; Electromagnetic Phenomena; Humans; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 33183035
DOI: 10.21037/apm-20-1956 -
Acta Cirurgica Brasileira Dec 2018To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP).
PURPOSE
To validate the porcine spine as a model for learning and practicing transforaminal percutaneous endoscopic lumbar procedures (TF-PELP).
METHODS
TF-PELP was performed in three porcine cadaver lumbar spine levels. Anatomical features of the current cadaver were compared to human and porcine spines. Performance and documentation of endoscopic procedures were described.
RESULTS
This study shows that this representative animal model reflects anatomical characteristics of the human spine. Transforaminal approaches were successfully completed. Although lower disc heights make disc puncture more difficult, the outside-in technique is feasible and more useful to identify anatomical parameters and to practice different surgical steps and maneuvers.
CONCLUSION
This is an effective and representative model for learning and practicing this procedure. Difficulties of the procedure, as well as the differences compared to the human spine, were described.
Topics: Anatomic Landmarks; Animals; Cadaver; Diskectomy, Percutaneous; Endoscopy; Fluoroscopy; Lumbar Vertebrae; Models, Animal; Needles; Reference Standards; Reference Values; Reproducibility of Results; Swine
PubMed: 30624513
DOI: 10.1590/s0102-865020180120000005 -
Neurology India 2022Minimally invasive spine surgery (MISS) is a set of techniques and procedures that reduces the local tissue injury while achieving the same results through traditional...
BACKGROUND AND INTRODUCTION
Minimally invasive spine surgery (MISS) is a set of techniques and procedures that reduces the local tissue injury while achieving the same results through traditional open surgery. The techniques for the treatment of lumbar disc herniation and degenerative canal stenosis have evolved from tubular discectomy to endoscopic discectomy. This helps in preserving spine function. Good clinical outcomes have been reported with the use of an endoscope for degenerative lumbar disc disease.
OBJECTIVE
In this video abstract, we present a case lumbar foraminal stenosis in an elderly man that was treated successfully using unilateral biportal endoscopic spine surgery. (UBESS).
SURGICAL TECHNIQUE
A 70-year-old man presented with progressive neurogenic claudication and left L4 numbness and paresthesias. His claudication distance was 200 m. His MRI Lumbosacral spine showed severe left L4-5 foraminal stenosis due to a disc prolapse. The patient underwent a left-sided unilateral biportal endoscopic transforaminal decompression and discectomy at L4-5 successfully. Postoperative period was uneventful and the patient had significant relief in his symptoms. Postoperative MRI Lumbosacral spine showed no muscle damage with adequate decompression at left L4-5 level.
RESULTS
The patient had an uneventful recovery.
CONCLUSION
Biportal percutaneous transforaminal endoscopic discectomy/decompression is an ideal alternative to the uniportal endoscopic and minimal invasive microsurgery for foraminal and paracentral disc herniations and lateral recess and foraminal stenosis.
Topics: Aged; Constriction, Pathologic; Decompression, Surgical; Diskectomy; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Treatment Outcome
PubMed: 35532611
DOI: 10.4103/0028-3886.344669 -
Revista Da Associacao Medica Brasileira... May 2018The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to... (Review)
Review
The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.
Topics: Brazil; Diskectomy, Percutaneous; Evidence-Based Medicine; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Magnetic Resonance Imaging; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 30304136
DOI: 10.1590/1806-9282.64.05.397 -
International Journal of Spine Surgery Apr 2022Various approaches are used for decompressive surgeries in the thoracic spine depending on the location and consistency of the pathology, always avoiding manipulation of...
BACKGROUND
Various approaches are used for decompressive surgeries in the thoracic spine depending on the location and consistency of the pathology, always avoiding manipulation of the thoracic spinal cord. Recently, there has been an effort to achieve adequate results and reduce morbidity with minimally invasive surgeries. Good outcomes and the advantages of full endoscopic spine surgery (FESS) have been proven for surgerical correction of herniated discs and stenoses in the lumbar and cervical spine. Similar evidence has recently been described for the thoracic spine, but it has not previously been reported in Brazil. Although the transforaminal approach is already established for the thoracic spine, the newly described interlaminar approach is equally efficient, and both techniques must be considered when treating thoracic spine diseases. The objective of the present article was to present the full endoscopic interlaminar and transforaminal techniques in patients with symptomatic disc herniation of the thoracic spine, discuss the rationality for implementing FESS in thoracic spine, and discuss the rationality in choosing between both approaches.
METHODS
Two patients were submitted to thoracic FESS. A transforaminal approach was chosen for a T10-T11 foraminal disc herniation; an interlaminar approach was selected for a paramedian T7-T8 disc extrusion. Data regarding operating time, intraoperative images, hospital stay, visual analog scales before and after FESS, course of recovery, and surgery satisfaction were evaluated.
RESULTS
The patients had eventless surgeries, improved from preoperative pain without morbidity. Both were satisfied and recovered well. Hospital stay was less than 6 hours after surgery.
CONCLUSIONS
Transforaminal and interlaminar FESS for thoracic disc herniation are safe, efficient, and minimally invasive alternatives.
CLINICAL RELEVANCE
Despite being an innovative technique with evident advantages, it should be carefully considered along with conventional technique for the treatment of thoracic spine diseases, since its clinical relevance is yet to be determined.
PubMed: 35444040
DOI: 10.14444/8209 -
Orthopaedic Surgery May 2021The purpose of the present study was to discuss a new surgical strategy that combines percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous...
OBJECTIVE
The purpose of the present study was to discuss a new surgical strategy that combines percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) for L4/5 and L5/S1 two-level disc herniation.
METHODS
This was a retrospective study. A total of 19 patients with L4/5 and L5/S1 two-level lumbar disc herniation (LDH) who underwent percutaneous endoscopic lumbar discectomy (PELD) in our hospital from January 2015 to June 2016 were retrospectively examined. The average age of these 19 patients was 42.21 ± 14.88 years old, including 12 men and 7 women. One experienced surgeon who had carried out more than 3000 lumbar surgeries performed PELD for these patients. During the PELD surgery, the transforaminal approach was adopted for L4/5 level disc herniation and the interlaminar approach was adopted for L5/S1 level disc herniation. The demographic data, operation time (min), fluoroscopy times, hospital stay (days), and complications were recorded and analyzed. The visual analogue scale (VAS), Oswestry disability index (ODI) scores, and the modified MacNab criteria were used to evaluate the surgical outcomes. MRI was conducted to evaluate the radiographic improvement.
RESULTS
All patients underwent PELD via the transforaminal approach combined with the interlaminar approach successfully and achieved satisfactory efficacy. The follow-up points were 3, 12, and 18 months. The average hospital stay (days) and the average follow up (months) were 3.32 ± 0.98 and 18.63 ± 3.84, respectively. The operation time and fluoroscopy times were 85.79 ± 12.90 min and 39.05 ± 4.59 times, respectively. The fluoroscopy times (frequency) for L4/5 and L5/S1 were 26.95 ± 6.41 and 12.11 ± 3.49 (t = 7.00, P < 0.05). Furthermore, there was no significant difference for fluoroscopy times between male and female patients (t = 0.89, P = 0.99). The preoperative back pain (VAS-Back) and the last follow-up VAS-Back were 5.58 ± 2.01 and 2.37 ± 1.01, respectively (t = 7.14, P < 0.05). The preoperative leg pain (VAS-Leg) and the last follow-up VAS-Leg were 7.00 ± 1.56 and 1.63 ± 1.01, respectively (t = 20.97, P < 0.05). There were significant differences between preoperative VAS-Back and the last follow-up VAS-Back in men (t = 4.61, P < 0.05) and women (t = 6.57, P < 0.05). In addition, there was significant differences between preoperative VAS-Leg and the last follow-up VAS-Leg in men (t = 13.48, P < 0.05) and women (t = 26.87, P < 0.05). There were significant differences between preoperative ODI scores (44.84 ± 10.82%) and the last follow-up ODI scores (11.12 ± 5.80%) (t = 10.92, P < 0.05). Preoperative ODI scores and the last follow-up ODI scores were significantly different for men (t = 8.80, P < 0.05) and women (t = 6.63, P < 0.05). All patients received significant pain relief and functional improvement after the surgery. Except for two cases of postoperative dysesthesia and one dural tear, no severe complications occurred. The dysesthesia symptoms of these two patients disappeared within 1 week with the application of dexamethasone and neurotrophic drugs and the dural tear case also recovered well as the dural laceration was small. No poor results were reported and 89.47% of patients achieved excellent or good recovery.
CONCLUSION
Percutaneous endoscopic lumbar discectomy via the transforaminal approach combined with the interlaminar approach under epidural anesthesia can treat L4/5 and L5/S1 two-level disc herniation safely and effectively.
Topics: Adult; Disability Evaluation; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Retrospective Studies
PubMed: 33821557
DOI: 10.1111/os.12862