-
Medicine Nov 2020Anterior cervical discectomy and fusion (ACDF) is the gold standard treatment for this cervical radiculopathy. Posterior endoscopic cervical foraminotomy (PECF), an... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Anterior cervical discectomy and fusion (ACDF) is the gold standard treatment for this cervical radiculopathy. Posterior endoscopic cervical foraminotomy (PECF), an effective alternative to ACDF, is becoming widely used by an increasing number of surgeons. However, comparisons of the clinical outcomes of ACDF and PECF remain poorly explored. The purpose of this study was to evaluate and compare visual analog scale (VAS)-arm scores, VAS-neck scores, neck disability index (NDI) scores, reoperation, and complications in PECF and ACDF.
MATERIALS AND METHODS
We comprehensively searched electronic databases or platforms, including PubMed, Web of Science, EMBASE, and the Cochrane Controlled Trial Center, using the PRISMA guidelines. The required information, including VAS-arm scores, VAS-neck scores, NDI scores, reoperation, and complications, was extracted from qualified studies and independently tested and compared by 2 researchers. The methodological index for nonrandomized studies was used to evaluate study quality.
RESULTS
Nine studies consisting of 230 males and 256 females were included. The mean age of the included patients was 49.6 years, and the mean follow-up time was 20.6 months. The VAS-arm scores were significantly higher, and VAS-neck scores and NDI scores of PECF showed greater improvement trends for PECF than ACDF. The complication proportion of patients with PECF was lower, while the proportion of reoperation was similar between PECF and ACDF. ACDF was the most common revision surgery. The most common complication of PECF was transient paresthesia.
CONCLUSION
Compared with ACDF, PECF is safe and effective in patients with unilateral cervical radiculopathy without myelopathy, and PECF does not increase the probability of reoperation and complications.
Topics: Cervical Vertebrae; Disability Evaluation; Endoscopy; Foraminotomy; Humans; Pain Measurement; Postoperative Complications; Radiculopathy; Reoperation
PubMed: 33157922
DOI: 10.1097/MD.0000000000022744 -
European Spine Journal : Official... Nov 2019The aim of this network meta-analysis (NMA) was to compare the complication rates of discectomy/microdiscectomy, percutaneous laser disc decompression (PLDD),... (Meta-Analysis)
Meta-Analysis
PURPOSE
The aim of this network meta-analysis (NMA) was to compare the complication rates of discectomy/microdiscectomy, percutaneous laser disc decompression (PLDD), percutaneous endoscopic lumbar discectomy (PELD), microendoscopic discectomy (MED), and tubular discectomy for symptomatic lumbar disc herniation (LDH).
METHODS
We searched three online databases for randomized controlled trials (RCTs). Overall complication rates, complication rates per general and modified Clavien-Dindo classification schemes, and reoperation rates were considered as primary outcomes. Odds ratio with 95% confidence intervals for direct comparisons and 95% credible intervals for NMA results were reported. Surface under cumulative ranking curve (SUCRA) was used to estimate ranks for each discectomy technique based on the complication rates.
RESULTS
In total, 18 RCTs with 2273 patients were included in this study. Our results showed that there was no significant difference in any of the pairwise comparisons. PELD (SUCRA: 0.856) ranked the lowest for overall complication rates. Discectomy/microdiscectomy (SUCRA: 0.599) and PELD (SUCRA: 0.939) ranked the lowest for intraoperative and post-operative complication rates, respectively. Concerning modified Clavien-Dindo classification scheme, PELD (SUCRA: 0.803), MED (SUCRA: 0.730), and PLDD (SUCRA: 0.605) ranked the lowest for the occurrence of type I, II, and III complications, respectively. Tubular discectomy (SUCRA: 0.699) ranked the lowest for reoperation rates.
CONCLUSIONS
The results of this NMA suggest that discectomy/microdiscectomy and PELD are the safest procedures for LDH with minimal intraoperative and post-operative complications, respectively. PELD, MED, and PLDD are the safest procedures for LDH in terms of minimal rates for complications necessitating conservative, pharmacological, and surgical treatment, respectively. These slides can be retrieved under Electronic Supplementary Material.
Topics: Diskectomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Postoperative Complications; Randomized Controlled Trials as Topic; Reoperation
PubMed: 31529215
DOI: 10.1007/s00586-019-06142-7 -
Pain Physician Jul 2021New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
New approaches and technologies can be beneficial for patients but also bring corresponding complications. Traditional pairwise meta-analyses cannot be used to comprehensively rank all surgical approaches.
OBJECTIVES
The purpose of this systematic review and network meta-analysis (NMA) was to compare the outcomes of different surgical approaches for lumbar disc herniation (LDH).
STUDY DESIGN
NMA of randomized controlled trials (RCTs) for multiple treatment comparisons of LDH.
METHODS
The PubMed, Embase, MEDLINE, Ovid, and Cochrane Library databases were searched for RCTs comparing different surgical approaches for patients with LDH from inception to February 10, 2020. The Markov chain Monte Carlo methods were used to perform a hierarchical Bayesian NMA in WinBUGS version 1.4.3 using a random effects consistency model. The primary outcomes were disability and pain intensity. The secondary outcomes were complications and reoperation. The PROSPERO number was CRD42020179406.
RESULTS
A total of 22 trials including 2529 patients and all 5 different approaches (open discectomy or microdiscectomy [OD/MD], microendoscopic discectomy [MED], percutaneous endoscopic discectomy [PED], percutaneous discectomy [PD], and tubular discectomy [TD]) were retrospectively retrieved. PED had the best efficacy in improving patients' dysfunction with no statistical significance (probability = 50%). PD was significantly worse than OD/MD, MED, and PED in relieving patients' pain (standardized mean differences: 0.87 [0.03, 1.76], 0.94 [0.06, 1.88], and 1.02 [0.13, 1.94], respectively). There was no statistically significant difference between any 2 surgical approaches in dural tear; intraoperative, postoperative, and overall complications; or reoperation rate. PED had the lowest dural tear rate and the lowest intraoperative and overall complication rates (probability = 51%, 67%, and 33%, respectively). TD had the lowest postoperative complication and reoperation rates (probability = 35% and 39%, respectively).
LIMITATIONS
The limitations of this NMA include the inconsistent follow-up times, the criteria for complications, and the reasons for reoperation.
CONCLUSIONS
Compared with other approaches used to treat LDH, PED had the best safety and efficacy in general, and TD had the lowest reoperation rate. Finally, we recommended PED for LDH.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Network Meta-Analysis
PubMed: 34213864
DOI: No ID Found -
Global Spine Journal Sep 2022Systematic review and meta-analysis.
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVES
Cervical spine endoscopic discectomy and decompression have gained popularity in the last decade. This review aimed to shed light on the current outcomes of cervical spine endoscopic procedures for degenerative disc disease (DDD) and to calculate a pooled estimate of various outcome measures.
METHODS
We retrieved articles published in English related to endoscopic cervical spine procedures from 3 central databases from inception until September 2020. A subgroup analysis based on the anterior versus the posterior approach was performed.
RESULTS
Thirty-one articles fulfilled the eligibility criteria and included 1,410 patients. A successful outcome was observed in 91.3% (88.6-93.4%, = 0.000). This percentage was lower for the anterior approach (89.6% [85.8-92.5%], = 0.000) than for the posterior approach (94.2% [90.4-96.5%], = 0.000). A higher percentage of poor outcomes was reported for the anterior approach (5.7% [3.2-10.1%], = 0.000 vs. 2.3% [1-5.5%], = 0.000 for the posterior approach). The overall complication rate was 7.2% (5.2-9.8%, = 0.000). There was a slightly higher complication rate for the anterior approach (7.9% [4.5-13.3%], = 0.000) than for the posterior approach (6.7% [4.4-10%], = 0.000). The revision rate was 4.2% (2.6-6.8%, = 0.000); and 4.2% (1.8-9.7%, = 0.000) for the anterior approach and 4.00% (2.2-7.4%, = 0.000) for the posterior approach.
CONCLUSIONS
There is a higher success rate and lower complication rate with the posterior approach than with the anterior approach. However, high-quality randomized controlled trials are vital to evaluate the efficacy of these procedures.
PubMed: 34402323
DOI: 10.1177/21925682211037270 -
World Neurosurgery Jun 2021Interlaminar endoscopic lumbar discectomy (IELD) is an efficient surgical treatment for lumbar disc herniation. However, this minimally invasive procedure requires a...
BACKGROUND
Interlaminar endoscopic lumbar discectomy (IELD) is an efficient surgical treatment for lumbar disc herniation. However, this minimally invasive procedure requires a considerable learning curve that has not yet been standardized. This review aimed to evaluate the learning curve's characteristics, including the cutoff point required to achieve technical proficiency and to discuss appropriate training methods.
METHODS
We systematically searched the core databases (PubMed, Embase, and Cochrane Library) for clinical studies that evaluated the learning curve using quantitative data. We performed a quality assessment using the Newcastle-Ottawa scale. We also compared descriptive statistics, including operative time and other variables before and after the cutoff point.
RESULTS
Six studies reporting 302 cases of IELD were selected from 7188 screened articles. The cutoff point was randomly set in 3 studies and determined as the curve's asymptote in 3 studies. The mean value for the cutoff point was 22.17 ± 12.40 cases (range: 10-43 cases) and mainly determined based on the operative time, which was shorter in the late group than that in the early group (P < 0.05). The cutoff points were not significant for patient outcome parameters such as pain score, functional result, surgical failure, or complications.
CONCLUSIONS
The evidence of published studies regarding the learning curve for the IELD technique is insufficient. The reported cutoff points may be significant only for task efficiency. Moreover, they may not represent the asymptote of the curve. Future studies should evaluate the actual plateau points using patient outcome data.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Learning Curve; Minimally Invasive Surgical Procedures; Neurosurgery; Professional Competence
PubMed: 33813075
DOI: 10.1016/j.wneu.2021.03.128 -
European Spine Journal : Official... Jan 2024Calcified lumbar disc herniation (CLDH) poses surgical challenges due to longstanding disease and adherence of herniated disc to the surrounding neural structures. The... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Calcified lumbar disc herniation (CLDH) poses surgical challenges due to longstanding disease and adherence of herniated disc to the surrounding neural structures. The data regarding outcomes after surgery for CLDH are limited. This review was conducted to analyse the surgical techniques, perioperative findings and the postoperative clinical outcomes after surgery for CLDH.
METHODS
PRISMA guidelines were followed whilst conducting this systematic review and meta-analysis. The literature review was conducted on 3 databases (PubMed, EMBASE, and CINAHL). After thorough screening of all search results, 9 studies were shortlisted from which data were extracted and statistical analysis was done. Pooled analysis was done to ascertain the perioperative and postoperative outcomes after surgery for CLDH. Additional comparative analysis was done compared to CLDH with non-calcified lumbar disc herniation (NCLDH) cases.
RESULTS
We included 9 studies published between 2016 and 2022 in our review, 8 of these were retrospective. A total of 356 cases of CLDH were evaluated in these studies with a male preponderance (56.4%). Mean operative time was significantly lower in NCLDH cases compared to CLDH cases. The mean estimated blood loss showed a negative correlation with the percentage of males. Satisfactory clinical outcomes were observed in majority of patients. The risk of bias of the included studies was moderate to high.
CONCLUSION
Surgical difficulties in CLDH cases leads to increase in operative time compared to NCLDH. Good clinical outcomes can be obtained with careful planning; the focus of surgery should be on decompression of the neural structures rather than disc removal.
Topics: Humans; Male; Intervertebral Disc Displacement; Retrospective Studies; Treatment Outcome; Lumbar Vertebrae; Diskectomy; Diskectomy, Percutaneous
PubMed: 37659048
DOI: 10.1007/s00586-023-07914-y -
Orthopaedics & Traumatology, Surgery &... Nov 2021Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health... (Review)
Review
BACKGROUND
Intraoperative imaging in minimally invasive spinal surgeries is associated with significant radiation exposure to surgeons, which overtime can lead to serious health hazards including malignancy. In this study, the authors conducted a systematic review to evaluate the efficacy of navigation assisted fluoroscopy methods on radiation exposure to the surgeon in minimally invasive spine surgeries, percutaneous endoscopic lumbar discectomy/percutaneous endoscopic transforaminal discectomy versus minimally invasive spine transforaminal lumbar interbody fusion (PELD/PETD versus MIS-TLIF).
METHODS
A systematic literature search was conducted using PUBMED/MEDLINE on 20th July, 2020. Inclusion criteria were applied according to study design, surgical technique, spinal region, and language. Data extracted included lumbar segment, average operation time (min), fluoroscopic time (s), and radiation dose (μSV), efficacy of modified navigation versus conventional techniques; on reducing operation, fluoroscopy times and effective radiation dose.
RESULTS
Fifteen studies (ten prospectives, and five retrospectives) were included for quantitative analysis. PELD recorded a shorter operation time (by 126.3min, p<0.001) and fluoroscopic time (by 22.9s, p=0.3) than MIS-TLIF. The highest radiation dose/case (μSV) for both techniques were recorded at the surgeon's: finger, chest, neck and eye. The effective dose for MIS-TLIF was 30μSV higher than PELD. Modified navigation techniques recorded a shorter operation time (by 15.9min, p=0.3); fluoroscopy time (by 289.8s, p=0.3); effective radiation dose (by 169.5μSV, p=0.3) than conventional fluoroscopy methods.
DISCUSSION
This systematic literature review showed that although navigation assisted fluoroscopy techniques are superior to conventional methods in minimising radiation exposure, lack of statistical significance warrants future randomised controlled trials, to solidify their efficacy in reducing radiation related hazards.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Minimally Invasive Surgical Procedures; Radiation Exposure; Spinal Fusion; Surgeons; Treatment Outcome
PubMed: 33333283
DOI: 10.1016/j.otsr.2020.102795 -
Spine Sep 2022
Meta-Analysis
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Sciatica; Treatment Outcome
PubMed: 35867477
DOI: 10.1097/BRS.0000000000004421 -
Applied Bionics and Biomechanics 2023[This retracts the article DOI: 10.1155/2022/5360277.].
Retracted: Short-Term Postoperative Pain and Function of Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Lumbar Discectomy for Single-Segment Lumbar Disc Herniation: A Systematic Review and Meta-analysis.
[This retracts the article DOI: 10.1155/2022/5360277.].
PubMed: 37946825
DOI: 10.1155/2023/9869037 -
British Journal of Neurosurgery Oct 2023Report of three patients undergoing lumbar epidural schwannoma tumourectomy. Percutaneous endoscopy has been routinely used in the treatment of disk herniation but has...
STUDY DESIGN
Report of three patients undergoing lumbar epidural schwannoma tumourectomy. Percutaneous endoscopy has been routinely used in the treatment of disk herniation but has not been reported in the management of intraspinal tumours.
METHODS
Three patients diagnosed with schwannoma by imaging and pathological examination underwent percutaneous full endoscopic tumourectomy. A 5-mm incision was made, the puncture needle passed through the skin, subcutaneous tissue and the deep fascia and vertebral muscles to the intervertebral foramen area. Next, a working cannula was inserted into the lesion area. Foraminotomy was completed by trephine and microscopic power drill if the foramen was stenosed. Tumour tissue was totally removed piecemeal. After probing the nerve foramen and the nerve root satisfactorily, the working cannula was removed and the incision sutured.
RESULTS
Three patients were operated successfully. Symptoms recovered in all cases and no complication or recurrence was found on follow-up.
CONCLUSIONS
This case report presents a new technique for non-infiltrating extradural lumbar tumour treatment, demonstrating feasibility and safety of percutaneous full endoscopic lumbar tumourectomy.
Topics: Humans; Treatment Outcome; Diskectomy, Percutaneous; Lumbar Vertebrae; Spinal Puncture; Endoscopy; Intervertebral Disc Displacement; Neurilemmoma; Retrospective Studies
PubMed: 33739902
DOI: 10.1080/02688697.2020.1821173