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Pain Physician Jan 2020Percutaneous endoscopic lumbar discectomy (PELD) often refers to percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar... (Review)
Review
BACKGROUND
Percutaneous endoscopic lumbar discectomy (PELD) often refers to percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). As a minimally invasive spinal procedure, PELD has gained increasing recognition for its small incision, quick recovery, short hospital stay, and equivalent clinical outcome compared to open surgery. In order to obtain satisfactory clinical efficacy, adequate consideration should be given regarding the indication of PELD. On the other hand, complications related to PELD will also significantly affect the safety and outcome of surgery.
OBJECTIVE
Our objective was to conduct a literature review of the indications and complications of PELD and to provide our experience in patient selection and solutions to complications related to PELD.
STUDY DESIGN
The study is a literature review focused on the indications and complications of PELD.
SETTING
The study is a literature review on the indications and complications of PELD.
METHODS
A comprehensive review of available literature on PELD was performed. Particular focus was given to the development of indications and prevention of complications. The literature was searched in PubMed database, and key words were set as "percutaneous endoscopic lumbar discectomy", "percutaneous endoscopic transforaminal discectomy", "percutaneous endoscopic interlaminar discectomy", "PELD", "PETD", "PEID", "YESS" and "TESSYS".
RESULTS
PELD is an effective and safe treatment for lumbar disc herniation, lumbar spinal stenosis, recurrent lumbar disc herniation, and other lumbar diseases. Complications related to PELD include dural tear, nerve root injury, recurrence, and so on.
LIMITATIONS
Some results drawn in this review are based on retrospective study or small sample size. Studies of larger sample size and more multicenter, randomized controlled trials should be conducted to evaluate the clinical efficacy and safety of PELD.
CONCLUSIONS
PELD is a promising surgical technique for lumbar diseases. Proper patient selection, excellent surgical skills, and rich experience are required for satisfactory outcomes.
KEY WORDS
Complications, indications, minimally invasive spine surgery, PELD.
Topics: Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbosacral Region; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 32013278
DOI: No ID Found -
Spine Apr 2021Systematic review and meta-analysis. (Comparative Study)
Comparative Study Meta-Analysis
STUDY DESIGN
Systematic review and meta-analysis.
OBJECTIVE
To give a systematic overview of effectiveness of percutaneous transforaminal endoscopic discectomy (PTED) compared with open microdiscectomy (OM) in the treatment of lumbar disk herniation (LDH).
SUMMARY OF BACKGROUND DATA
The current standard procedure for the treatment of sciatica caused by LDH, is OM. PTED is an alternative surgical technique which is thought to be less invasive. It is unclear if PTED has comparable outcomes compared with OM.
METHODS
Multiple online databases were systematically searched up to April 2020 for randomized controlled trials and prospective studies comparing PTED with OM for LDH. Primary outcomes were leg pain and functional status. Pooled effect estimates were calculated for the primary outcomes only and presented as standard mean differences (SMD) with their 95% confidence intervals (CI) at short (1-day postoperative), intermediate (3-6 months), and long-term (12 months).
RESULTS
We identified 2276 citations, of which eventually 14 studies were included. There was substantial heterogeneity in effects on leg pain at short term. There is moderate quality evidence suggesting no difference in leg pain at intermediate (SMD 0.05, 95% CI -0.10-0.21) and long-term follow-up (SMD 0.11, 95% CI -0.30-0.53). Only one study measured functional status at short-term and reported no differences. There is moderate quality evidence suggesting no difference in functional status at intermediate (SMD -0.09, 95% CI -0.24-0.07) and long-term (SMD -0.11, 95% CI -0.45-0.24).
CONCLUSION
There is moderate quality evidence suggesting no difference in leg pain or functional status at intermediate and long-term follow-up between PTED and OM in the treatment of LDH. High quality, robust studies reporting on clinical outcomes and cost-effectiveness on the long term are lacking.Level of Evidence: 2.
Topics: Cost-Benefit Analysis; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery; Pain Measurement; Prospective Studies; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 33290374
DOI: 10.1097/BRS.0000000000003843 -
World Neurosurgery Aug 2020Spine surgery has evolved over centuries from first being practiced with Hippocratic boards and ladders to now being able to treat spinal pathologies with minimal tissue... (Review)
Review
Spine surgery has evolved over centuries from first being practiced with Hippocratic boards and ladders to now being able to treat spinal pathologies with minimal tissue invasion. With the advent of new imaging and surgical technologies, spine surgeries can now be performed minimally invasively with smaller incisions, less blood loss, quicker return to daily activities, and increased visualization. Modern minimally invasive procedures include percutaneous pedicle screw fixation techniques and minimally invasive lateral approach for lumbar interbody fusion (i.e., minimally invasive transforaminal lumbar interbody fusion, extreme lateral interbody fusion, oblique lateral interbody fusion) and midline lumbar fusion with cortical bone trajectory screws. Just as evolutions in surgical techniques have helped revolutionize the field of spine surgery, imaging technologies have also contributed significantly. The advent of computer image guidance has allowed spine surgeons to advance their ability to refine surgical techniques, increase the accuracy of spinal hardware placement, and reduce radiation exposure to the operating room staff. As the field of spine surgery looks to the future, many novel technologies are on the horizon, including robotic spine surgery, artificial intelligence, and machine learning to help improve preoperative planning, improve surgical execution, and optimize patient selection to ensure improved postoperative outcomes and patient satisfaction. As more spine surgeons begin incorporating these novel minimally invasive techniques into practice, the field of minimally invasive spine surgery will continue to innovate and evolve over the coming years.
Topics: Artificial Intelligence; Decompression, Surgical; Diskectomy; Diskectomy, Percutaneous; History, Ancient; Humans; Lumbar Vertebrae; Machine Learning; Minimally Invasive Surgical Procedures; Neuroendoscopy; Neurosurgical Procedures; Patient Satisfaction; Patient Selection; Robotic Surgical Procedures; Spinal Diseases; Spinal Fusion; Treatment Outcome
PubMed: 32434014
DOI: 10.1016/j.wneu.2020.05.071 -
Medicine Feb 2023The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective...
The effect of spinal anatomical anomalies on the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for disc herniation repair is unclear. This retrospective review aims to assess the safety and effectiveness of PELD for treating L5-S1 disc herniation with a range of characteristics and to determine the prevalence of lumbosacral transitional vertebrae (LSTV) anatomical anomalies to facilitate pre-surgical planning. From July 2005 to June 2019, 345 patients with L5-S1 disc herniations were treated with PELD. The primary outcome was 1-year postoperative visual analogue scale scores for low back and lower limb pain. The secondary outcomes included the surgical approach used, lumbosacral bony anomalies, presence of a ruptured disc or severely calcified disc, pediatric lumbar disc herniation, recurrent disc herniation management, and the long-term outcome. visual analogue scale scores for most patients were significantly improved after surgery. The prevalence of LSTVs was 4.05% (14/345 patients) in lumbar sacralization and 7.53% (26/345 patients) in sacral lumbarization. The prevalence of ruptured and severely calcified discs was 18.55% (64/345) and 5.79% (20/345), respectively. The prevalence of pediatric lumbar disc herniation was 2.02% (7/345). The recurrence rate was 4.34% (15/345). Two durotomy cases without sequelae and 8 cases of lower limb dysesthesia lasting longer than 3 months postoperatively were reported. PELD is safe and effective for treating L5-S1 disc herniation, including cases complicated by calcified lumbar disc herniation, disc rupture with migration, and the presence of LSTV. Appropriate imaging is essential to identify case-specific factors, including the prevalent LSTV anatomical anomalies, before surgery.
Topics: Humans; Child; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Retrospective Studies; Lumbar Vertebrae; Endoscopy; Lumbosacral Region; Treatment Outcome
PubMed: 36749265
DOI: 10.1097/MD.0000000000032832 -
Journal of Orthopaedic Surgery and... Jan 2022Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while...
BACKGROUND
Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH.
METHODS
The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria.
RESULTS
The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups.
CONCLUSIONS
Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.
Topics: Adult; Aged; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain; Retrospective Studies; Treatment Outcome
PubMed: 35033143
DOI: 10.1186/s13018-022-02929-5 -
Ugeskrift For Laeger Oct 2023The technical development has caused a reintroduction of endoscopic techniques directed towards degenerative spine disease. A summary of the endoscopic procedure is... (Review)
Review
The technical development has caused a reintroduction of endoscopic techniques directed towards degenerative spine disease. A summary of the endoscopic procedure is given in this review. The spinal canal is reached through an inter-laminar or transforaminal access. In comparison with open surgery the percutaneous transforaminal access seems especially advantageous for the removal of paramedian and/or foraminal herniated disc material. However, careful patient selection is required, as the restricted manoeuverability and working zone of the endoscope and patient specific pathoanatomy in some cases will disfavour endoscopy.
Topics: Humans; Intervertebral Disc Displacement; Diskectomy, Percutaneous; Treatment Outcome; Lumbar Vertebrae; Endoscopy; Retrospective Studies
PubMed: 37921109
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Aug 2023To determine the safety and efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) hydrogel injection in patients with...
OBJECTIVE
To determine the safety and efficacy of percutaneous endoscopic lumbar discectomy (PELD) combined with platelet-rich plasma (PRP) hydrogel injection in patients with lumbar disc herniation (LDH).
METHODS
A total of 98 consecutive patients with LDH who underwent either PELD combined with PRP hydrogel injection or PELD alone were reviewed. This retrospective study was performed between January 2019 and January 2021. Clinical outcomes were compared in the visual analog scale (VAS) for low back pain and leg pain, Oswestry disability index (ODI), Japanese Orthopaedic Association (JOA) scores, and Macnab criteria. Intervertebral disc height on MRI was measured, and the Pfirrmann grade classification was used pre-operatively and post-operatively.
RESULTS
No severe adverse events were reported during an 18-month follow-up period. VAS scores for back pain were decreased at 1 month, 3 months, and 18 months in the treatment group than that in the control group. JOA score and ODI in the treatment group at 3-month and 18-month follow-up was lower than that in the control group (P < 0.05). The excellent and good rate of the Macnab criteria was 92.0% (46/50) in the treatment group and 89.6% (43/48) in the control group (P > 0.05). The comparison of Pfirrmann grading and disc height at 18-month follow-up showed significant difference in two groups (P < 0.05). The recurrence of LDH in the treatment group was lower than that in the control group (P < 0.05).
CONCLUSIONS
We suggest that PELD combined with PRP hydrogel injection to treat patients with LDH is a safe and promising method. PRP injection was beneficial for disc remodelling after PELD.
Topics: Humans; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Hydrogels; Retrospective Studies; Lumbar Vertebrae; Diskectomy
PubMed: 37605261
DOI: 10.1186/s13018-023-04093-w -
World Neurosurgery Jan 2021As an essential component of minimally invasive spine surgery, endoscopic spine surgery (ESS) has continuously evolved and has been accepted as a practical procedure by... (Review)
Review
As an essential component of minimally invasive spine surgery, endoscopic spine surgery (ESS) has continuously evolved and has been accepted as a practical procedure by the worldwide spine community. Especially for lumbar disc herniation (LDH), the percutaneous endoscopic or full-endoscopic discectomy technique has been scientifically proven through randomized controlled trials and meta-analyses to be a good alternative to open discectomy. The initial concept of endoscopic spine discectomy was concerned with indirect disc decompression using various instruments such as blind forceps, a nucleotome, laser, radiofrequency coblation, and some chemical agents. The main surgical field has been shifted from the intradiscal space to the epidural space. Precise and selective discectomy for extruded LDH in the epidural space under high-quality endoscopic visualization is now feasible. Furthermore, the medical applications of ESS is broadening to include spinal stenosis, segmental instability, infection, and even intradural lesions. In this review article, I describe the history of endoscopic spine discectomy and decompression techniques, as well as evolution of the paradigm. This history may help indicate the future of practical ESS.
Topics: Diskectomy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Minimally Invasive Surgical Procedures; Neuroendoscopy
PubMed: 32781148
DOI: 10.1016/j.wneu.2020.08.008 -
World Neurosurgery Jan 2021Transforaminal endoscopic spine surgery (T-ESS) has become a well-accepted technique. The first attempts at percutaneous discectomy by Kambin and Hijikata opened a new... (Review)
Review
Transforaminal endoscopic spine surgery (T-ESS) has become a well-accepted technique. The first attempts at percutaneous discectomy by Kambin and Hijikata opened a new chapter of endoscopic spine surgery. By the last quarter of the twentieth century, spine surgeons had begun to adopt this novel technique. Many researchers helped advance endoscopic spine surgery, but the turning point was the description of a safe transforaminal triangle of safety by Parviz Kambin. Since then, the indications for T-ESS have increased as a result of the description of different surgical approaches such as inside-out, outside-in, and half-and-half. We present a review of crucial historical advancements in T-ESS and also discuss the evolution of endoscopes, the techniques used, development of endoscopic instruments and equipment, transforaminal thoracic endoscopy, transforaminal endoscopic interbody fusions, the growth of extended indications, and the future direction of T-ESS. This review provides a detailed description of key historical moments and a bird's-eye view of the vast scope of T-ESS.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Degeneration; Minimally Invasive Surgical Procedures; Neuroendoscopes; Neuroendoscopy; Spinal Diseases
PubMed: 32822954
DOI: 10.1016/j.wneu.2020.08.096 -
World Neurosurgery May 2023Unilateral biportal endoscopic discectomy (UBED) is a novel and minimally invasive surgery for lumbar disc herniation (LDH). However, efficacy and safety of UBED... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Unilateral biportal endoscopic discectomy (UBED) is a novel and minimally invasive surgery for lumbar disc herniation (LDH). However, efficacy and safety of UBED compared to the conventional percutaneous endoscopic lumbar discectomy (PELD) remains to be determined. A meta-analysis was performed in this study to compare between UBED and PELD for LDH.
METHODS
Relevant cohort studies were found by searching Medline, Web of Science, Embase, Wanfang, and CNKI from database inception to October 13, 2022. Results were pooled using a random-effects model incorporating heterogeneity.
RESULTS
In this meta-analysis, 12 studies involving 1175 patients with LDH were included. Pooled results showed that compared with PELD, UBED was associated with a longer surgery time (mean difference [MD] 17.62 min, P < 0.001) and hospital stay (MD 1.40 day, P = 0.04). However, UBED and PELD showed comparative efficacies in improving the Visual Analogue Scale of leg and back, and Oswestry Disability Index, scores. The incidence of perioperative complications was not significantly different between the 2 procedures (risk ratio [RR] 1.62, P = 0.25), while UBED was associated with a lower LDH recurrence during follow-up (RR 0.29, P = 0.03).
CONCLUSIONS
Although UBED is associated with longer surgery time and hospital stay, it shows similar efficacy to PELD in relieving pain and improving functional ability in patients with LDH. In addition, limited evidence suggests that UBED may be associated with a lower LDH recurrence as compared to PELD, while the incidence of perioperative complications is not different. These findings support UBED as a treatment for patients with LDH.
Topics: Humans; Diskectomy, Percutaneous; Intervertebral Disc Displacement; Lumbar Vertebrae; Diskectomy; Endoscopy; Treatment Outcome; Retrospective Studies
PubMed: 36841538
DOI: 10.1016/j.wneu.2023.02.087