-
Orthopaedic Surgery Jan 2022To investigate the feasibility and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) with three-step maneuver for puncture (TSMP) for lumbar herniated...
OBJECTIVE
To investigate the feasibility and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) with three-step maneuver for puncture (TSMP) for lumbar herniated disc (LDH).
METHODS
We performed a retrospective review of 30 patients who underwent PTED using TSMP for LDH and met inclusion criteria from January 2018 to September 2018. The primary outcome, leg or back pain, was assessed using Visual Analogue Scale (VAS). Patient surgical satisfaction was measured at 12 months post surgery using a five-point Likert scale. Potential prognostic factors measured were demographic characteristics, duration of symptom (DOS), and involved levels. Statistical analysis was performed using Fisher exact test and t-test. TSMP is a three-step maneuver that builds on the concept of needle puncture site and trajectory determination based on the principles of Kambin's triangle. First, accurate direction of the puncture is confirmed by inserting the needle horizontally. Then by gradually raising the needle tail in the manner described, the superior articular facet and the intervertebral foramen are sequentially located. Finally, the needle tip slides into the intervertebral foramen to reach the target superior articular facet.
RESULTS
Preoperative mean VAS was 7.6 ± 1.19, which decreased to 1.4 ± 0.97 at 12 months following treatment (P < 0.0001). Rates of surgical satisfaction per Likert scale were as follows: very satisfied and satisfied in 26 patients (86.7%). Three recurrent disc herniations of adjacent segmental levels were observed in the L5-S1 group at eight and 12 months after surgery. VAS scores at 12 months varied significantly between L4-L5 level surgery and L5-S1 level surgery groups (P < 0.01).
CONCLUSION
TSMP is a reliable technique for puncture into the intervertebral foramen.
Topics: Adult; Diskectomy, Percutaneous; Endoscopy; Feasibility Studies; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Punctures; Retrospective Studies; Treatment Outcome
PubMed: 34873865
DOI: 10.1111/os.13113 -
Clinical Spine Surgery Mar 2023A systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis
Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy: A Systematic Review and Meta-analysis.
STUDY DESIGN
A systematic review and meta-analysis.
OBJECTIVE
The objective of this study was to compare the safety of microscopic anterior cervical discectomy and fusion (MI-ACDF) and posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) in patients diagnosed with single-level unilateral cervical radiculopathy.
SUMMARY OF BACKGROUND DATA
After conservative treatment, the symptoms will be relieved in about 90% of cervical radiculopathy patients. For the other one tenth of patients, surgical treatment is needed. The overall complication rate of MI-ACDF and PPEKF ranges from 0% to 25%, and the reoperation rate ranges from 0% to 20%.
MATERIALS AND METHODS
Electronic retrieval of studies from PubMed, Embase, and Cochrane Library was performed to identify comparative or single-arm studies on MI-ACDF and PPEKF. A total of 24 studies were included in our meta-analysis by screening according to the inclusion and exclusion criteria. After data extraction and quality assessment of the included studies, a meta-analysis was performed by using the R software. The pooled incidences of efficient rate, total complication rate, and reoperation rate were calculated.
RESULTS
A total of 24 studies with 1345 patients (MI-ACDF: 644, PPEKF: 701) were identified. There was no significantly statistical difference in pooled patient effective rate (MI-ACDF: 94.3% vs. PPEKF: 93.3%, P =0.625), total complication rate (MI-ACDF: 7.1% vs. PPEKF: 4.7%, P =0.198), and reoperation rate (MI-ACDF: 1.8% vs. PPEKF: 1.1%, P =0.312). However, the common complications of the 2 procedures were different. The most common complications of MI-ACDF were dysphagia and vertebral body sinking, whereas the most common complication of PPEKF was nerve root palsy.
CONCLUSIONS
Both MI-ACDF and PPEKF can provide a relatively safe and reliable treatment for single-level unilateral cervical radiculopathy. The 2 techniques are not significantly different in terms of effective rate, total complication rate, and reoperation rate.
Topics: Humans; Foraminotomy; Radiculopathy; Cervical Vertebrae; Treatment Outcome; Diskectomy; Spinal Fusion
PubMed: 35344521
DOI: 10.1097/BSD.0000000000001327 -
Medicine Nov 2018The aim of this study is to observe the therapeutic effect of percutaneous endoscopic discectomy and its influencing factors for lumbar disc herniation and compare the... (Comparative Study)
Comparative Study
The aim of this study is to observe the therapeutic effect of percutaneous endoscopic discectomy and its influencing factors for lumbar disc herniation and compare the advantages and disadvantages of transforaminal and interlaminar of percutaneous endoscopy.Data from 143 patients with lumbar disc herniation were respectively collected, including demographic and clinical data. Study population were divided into curative effect group and poor curative effect group, and logistic regression was used to explore the influencing factors of curative effect. The operation data and pre-and post-operation scores were compared to explore the effect of transforaminal and interlaminar approach on surgery efficacy.The rate of curative effect was 93.7%. 120 patients were classified as curative group and 23 patients were categorized as poor effective group. Univariate analysis found that the patients in the curative effect group tended to receive the interlaminar approach (58.3% vs 34.8%, P = .038). Multivariate logistic regression did not find operation approach was not related to curative effect of operation (transforaminal and interlaminar). But age ≥45 (odd risk (OR) = 6.43, P = .016), course of disease >12 month (OR = 3.77, P = .003), back and leg pain (OR = 3.46, P = .026), history of trauma (OR = 3.88, P = .014), Pfirrmann level IV (OR = 4.84, P = .004), and pre-Visual Analogue Scale (VAS) <5.3 (OR = 3.63, P = .015) were associated with operation efficacy. Compared with transforaminal group, the interlaminar group has less operative time (P = .000), less fluoroscopy time (P = .000), less puncture time (P = .000), less blood loss (P = .011).The transforaminal or interlaminar did not affect the treatment efficacy of percutaneous endoscopic discectomy for lumbar disc herniation. The selection of surgery approach depended on anatomical structure and physiological characteristics. It should be noted that 45 years of age or older, in the course of more than 12 months, both lumbocrural pain and lumbar disc herniation with grade IV, with history of trauma, may have impact on the efficacy of surgery.
Topics: Adult; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Length of Stay; Logistic Models; Lumbar Vertebrae; Male; Middle Aged; Operative Time; Pain, Postoperative; Retrospective Studies; Treatment Outcome
PubMed: 30508947
DOI: 10.1097/MD.0000000000013417 -
Turkish Neurosurgery 2020To compare the efficacy of percutaneous transforaminal endoscopic discectomy with and without epidural steroid application in the treatment of lumbar disc herniation. (Comparative Study)
Comparative Study
Comparison of Percutaneous Transforaminal Endoscopic Discectomy with and without Epidural Steroid Application in the Treatment of Lumbar Disc Herniation: A Minimum of 2 Years of Follow-Up.
AIM
To compare the efficacy of percutaneous transforaminal endoscopic discectomy with and without epidural steroid application in the treatment of lumbar disc herniation.
MATERIAL AND METHODS
A total of 101 patients who had indications for percutaneous transforaminal endoscopic discectomy were retrospectively reviewed. Patients were divided into two groups based on whether epidural steroids were applied following the surgical procedure. Each patient in group A received an epidural injection of 40mg triamcinolone acetonide through the working sleeve following the surgical procedure. However, patients in group B were not given the drug. Preoperative and postoperative radicular pain was measured with the visual analogue scale (VAS). Functional and satisfaction outcomes were measured with the Oswestry Disability Index (ODI) and the modified MacNab criteria, respectively.
RESULTS
A total of 97 patients had a complete follow-up of longer than two years without recurrence. The sample sizes of group A and group B were 56 and 41. The VAS scores and ODI scores at each postoperative follow-up point were significantly lower than the preoperative values (p < 0.001). However, there were no significant between-group differences (p > 0.05). The secondary outcomes of the changes in the VAS and ODI scores were also equivalent between the groups at the 3-month and 2-year follow-ups (p > 0.05). No significant difference was observed in the modified MacNab criteria between the groups at 2 years (p=0.7715).
CONCLUSION
Percutaneous transforaminal endoscopic discectomy is a safe and effective minimally invasive surgery for radiculopathy caused by lumbar disc herniation. Epidural steroid injection following the surgical procedure offered no benefit compared with surgery alone.
Topics: Adult; Diskectomy, Percutaneous; Female; Follow-Up Studies; Humans; Injections, Epidural; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Minimally Invasive Surgical Procedures; Neuroendoscopy; Pain, Postoperative; Retrospective Studies; Steroids; Time Factors
PubMed: 32239482
DOI: 10.5137/1019-5149.JTN.26972-19.2 -
Global Spine Journal Jun 2022Systematic review.
STUDY DESIGN
Systematic review.
OBJECTIVE
The authors aimed to systematically compare the effectiveness and safety of endoscopic discectomy (ED) with non-endoscopic discectomy (NED) for treatment of symptomatic lumbar disc herniation (LDH).
METHODS
A systematic search was performed on PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure for randomized controlled trial from inception until August 13, 2020. Trials which investigated multiple operative approaches on lumbar disc herniation were identified without language restrictions.
RESULTS
In total, 25 trials involving 2258 patients with symptomatic LDH were included. Twenty trials performed the comparison between ED and NED. Five trials performed the comparison between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). The operative time of micro-endoscopic discectomy (MED) was longer than open discectomy (OD). The length of hospital stay of percutaneous endoscopic lumbar discectomy (PELD) was shorter than fenestration discectomy (FD). Significant differences in intraoperative blood loss volumes were found between PELD with FD and MED with OD. The complication rate of PELD was lower than FD (PELD: 4.3%; FD: 14.6%) and the complication rate of full-endoscopic discectomy (FE) was lower than microscopic discectomy (MD) (FE: 13.4%; MD: 32.1%).
CONCLUSIONS
PELD and FE have the advantage of limiting intraoperative damages. ED and NED can be both considered sufficient to achieve good clinical outcomes. PETD and PEID are able to achieve similar results but the learning curve of PETD was steeper. More independent high-quality RCTs with sufficiently large sample sizes performing cost-effectiveness analyzes are needed.
PubMed: 34402320
DOI: 10.1177/21925682211020696 -
Pain Physician Jul 2021Although many studies have compared full endoscopic spine surgery and open spine surgery, few have compared the outcomes of percutaneous endoscopic interlaminar lumbar... (Observational Study)
Observational Study
BACKGROUND
Although many studies have compared full endoscopic spine surgery and open spine surgery, few have compared the outcomes of percutaneous endoscopic interlaminar lumbar discectomy (PEILD) and open lumbar microdiscectomy (OLM) at the L5-S1 level.
OBJECTIVES
We compared the clinical, surgical, and radiological outcomes of patients with disc herniation at the L5-S1 level who underwent either PEILD, or OLM, performed by a single surgeon with novice-level proficiency.
STUDY DESIGN
Observational, retrospective matched cohort design.
SETTING
An analysis of clinical data was performed at a single center, collected from September 2012 to August 2016.
METHODS
The study enrolled 56 patients who underwent discectomy at the L5-S1 level, with a minimum one-year follow-up. Patients were allocated to 2 groups: a PEILD group (n = 27; September 2014 to August 2016), or an OLM group (n = 29; September 2012 to August 2014). Clinical, surgical, and radiological outcomes were retrospectively evaluated.
RESULTS
Baseline characteristics including age, gender, past medical history, body mass index, preoperative symptom, and preoperative radiological findings did not differ significantly between the groups. Further, overall clinical outcomes including back and leg pain; surgical outcomes including blood loss, complication rate, and recurrence rate; and radiological outcomes including degree of decompression, disc height, and sagittal alignment were not different significantly between the 2 groups.However, the PEILD group showed significant advantages including lower immediate postoperative back pain (mean 1.44 [95% confidence interval (CI), 1.16-1.72] versus 2.41 [95% CI, 2.14-2.69], P < 0.001), favorable immediate postoperative Odom's criteria (excellent 57.14% versus 24.14%, P = 0.025), shorter operation time (mean 63.89 ±17.99 minutes versus 109.66 ±31.42 minutes, P < 0.001), shorter hospital stay (3.15 [95% CI, 2.21-4.09] days versus 5.72 [95% CI, 3.29-8.16] days, P < 0.001), and rapid return to work (15.67 [95% CI, 12.64-18.69] days versus 24.31 [95% CI ,19.97-28.65] days, P = 0.001).
LIMITATION
Due to its retrospective nature, it was not possible to control for all variations. Moreover, the number of patients in the final cohort was relatively small.
CONCLUSIONS
Our findings indicate that the PEILD group achieved better perioperative outcomes despite no significant intergroup difference in mid-term clinical and radiological outcomes.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 34213872
DOI: No ID Found -
Pain Physician Aug 2022Symptomatic herniated intervertebral discs are debilitating. However, surgical management poses a significant challenge for endoscopic spine surgeons, especially in...
BACKGROUND
Symptomatic herniated intervertebral discs are debilitating. However, surgical management poses a significant challenge for endoscopic spine surgeons, especially in high-grade migrated lesions.
OBJECTIVES
This study aimed to assess the surgical and clinical outcomes after applying a computed tomography navigated percutaneous endoscopic lumbar discectomy.
STUDY DESIGN
The data of patients with high-grade lumbar disc migration who underwent percutaneous endoscopic lumbar discectomy at our spine center were retrospectively collected and analyzed from November 2017 to May 2019. The patients were divided into 2 groups based on different workflows, with group O who underwent percutaneous endoscopic lumbar discectomy with computed-tomography navigation (O-arm), and group C who underwent conventional fluoroscopic guidance (C-arm).
SETTING
Twenty-one (n = 21) patients were enrolled with data fully documented. There were 9 patients in group O (n = 9) and 12 patients in group C (n = 12).
METHODS
An intraoperative 3-dimensional image was obtained using the O-arm device (O-arm®, Medtronic, Inc., Louisville, CO, United States) after patient positioning in group O, and enable multiplanar visualization during exploring the entry point, trajectory, orientation, and finally discectomy. In group C, conventional imaging scanner intensifier (C-arm) was used during the procedure.
RESULTS
The operative time (99.4 ± 40.7 vs 86.9 ± 47.9 minutes, P = .129), blood loss (11.1 ± 15.7 vs 6.7 ± 8.2 mL, P = .602), and hospital stay (2.9 ± 0.3 vs 2.8 ± 0.6 days, P = .552) were similar between the 2 groups. However, group O showed more reduction in the pain and faster functional recovery immediately after the surgery (Visual Analog Score [VAS]: -9 vs -6.7, P =.277; Oswestry Disability Index [ODI]: -53.2% vs -29.1%, P = 0.006) and during the one-year follow-up (VAS: -8.1 vs -7.3, P =.604; ODI: -56.7% vs -40.1%, P = .053) compared with group C.
LIMITATIONS
The retrospective nature of the study design, the small population size, and the shorter period of follow-up required further study.
CONCLUSIONS
Computed tomography-navigated percutaneous endoscopic surgery is safe and effective for lumbar disc herniation with high-grade migration, and enhance early functional recovery even compared with conventional fluoroscopic guidance.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Imaging, Three-Dimensional; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Surgery, Computer-Assisted; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 35901489
DOI: No ID Found -
Medical Science Monitor : International... Mar 2019BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are alternative minimally invasive, widely performed procedures... (Meta-Analysis)
Meta-Analysis
BACKGROUND Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are alternative minimally invasive, widely performed procedures for the treatment of lumbar disc herniation (LDH). This study compared the clinical outcomes of these 2 surgical techniques in treating LDH. MATERIAL AND METHODS A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar to identify all relevant studies comparing PTED and MED in treating LDH. RESULTS Eight comparative studies assessing a total of 805 patients were included for the final analysis. The results indicated that PTED needs a shorter incision [-1.02 (-1.21 to -0.83), p<0.001], less time in bed [-2.14 (-3.34 to -0.94), p<0.001], and shorter hospital stay [-1.92 (-2.90 to -0.94), p<0.001], whereas MED is superior regarding intraoperative fluoroscopy [7.47 (2.78 to 12.17), p=0.002] and total cost [0.69 (0.38 to 1.00), p<0.001]. No significant differences were found on operation time, intraoperative blood loss, or complications. Significant lower back pain was found in the PTED group at 1 week postoperatively [-0.52 (-0.95 to -0.10), p=0.02] and 1 year postoperatively or the last follow-up [-0.41 (-0.76 to -0.06), p=0.02]; significant lower leg pain was also detected at 1 week postoperatively [-0.52 (-0.75 to -0.30), p<0.001]. Oswestry Disability Index (ODI) was significant better at 1 week postoperatively in the PTED group [-4.41 (-7.03 to -1.79), p=0.001]. No significant differences were detected at other time points regarding pain score and ODI. CONCLUSIONS Both PTED and MED are safe and effective techniques for treating LDH. However, taking all clinical outcomes together, PTED might be a preferable treatment modality for LDH.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Middle Aged; Operative Time; Pain Measurement; Postoperative Period; Retrospective Studies; Treatment Outcome
PubMed: 30927349
DOI: 10.12659/MSM.913326 -
BioMed Research International 2020Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have...
BACKGROUND
Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH.
METHODS
Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria.
RESULTS
The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values ( < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate ( < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate ( < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (.
CONCLUSIONS
PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.
Topics: Adolescent; Adult; Aged; Cohort Studies; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Follow-Up Studies; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Physical Examination; Postoperative Period; Treatment Outcome; Visual Analog Scale; Young Adult
PubMed: 32190653
DOI: 10.1155/2020/1852070 -
Annals of Palliative Medicine Aug 2022For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for... (Meta-Analysis)
Meta-Analysis
BACKGROUND
For some patients, local anesthesia (LA) in percutaneous transforaminal endoscopic discectomy (PTED), especially during canal shaping and discectomy, is insufficient for analgesia. Epidural anesthesia (EA) is infrequently applied in PTED but reports satisfactory results. Previous studies present conflicting results in analgesia satisfactory and adverse events. Differences in surgery details and small sample size might explain conflicting results. Meta-analysis pools the results from individual studies to create a larger sample size and provides a more reliable conclusion. The aim of this study is to evaluate the efficacy and safety of EA in PTED.
METHODS
The search terms "percutaneous transforaminal endoscopic discectomy" and "anesthesia" are used to search Cochrane, Web of Science, PubMed, Embase, OVID, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang from inception to 2021-08. Inclusion criteria is defined according to PICOS principals: P (patients): patients are diagnosed with lumbar disc herniation or spinal canal stenosis. I (intervention): patients undergo PTED under EA. C (comparisons): patients undergo PTED under LA. O (outcomes): primary outcomes: intraoperative visual analogue scale (VAS), anesthesia satisfactory, sufentanil usage. Secondary outcomes: adverse events, surgery exit, bleed volume, X-ray radiation. S (study design): randomized controlled trials (RCTs). The Cochrane RoB 2.0 is used to evaluate the quality of the included studies. Authors perform meta-analysis through Review Manager 5.4.
RESULTS
A total of 6 studies representing 529 patients are included: EA group includes 261 patients, and LA group includes 268 patients. All studies lack design of allocation concealment and blinding of participants and personnel. Only Luo reports blinding of outcome assessment in 2019. Meta analysis concludes that EA is superior in intraoperative analgesic [mean difference (MD) =-4.31; 95% confidence interval (CI): -4.52 to -4.09; P<0.00001], anesthesia satisfactory [odds ratio (OR) =10.06; 95% CI: 2.41 to 41.98; P=0.002], sufentanil usage (MD =-9.12; 95% CI: -10.34 to -7.90; P<0.00001), adverse events (OR =0.19; 95% CI: 0.07 to 0.52; P=0.001). There is no difference in bleed volume (MD =-2.61; 95% CI: -5.45 to 0.23; P=0.07), exit rate (OR =0.23; 95% CI: 0.04 to 1.35; P=0.10) and future effects (MD =-0.23; 95% CI: -0.50 to 0.03; P=0.08).
DISCUSSION
EA is an effective and safe anesthesia method for PTED and might achieve better clinical results than LA. More high-quality research is needed to provide high-quality evidence for efficacy and safety.
Topics: Anesthesia, Epidural; Anesthesia, Local; Diskectomy; Humans; Lumbar Vertebrae; Sufentanil; Treatment Outcome
PubMed: 35871273
DOI: 10.21037/apm-21-3413