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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 -
Pain Research & Management 2022To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who...
OBJECTIVES
To compare the viability of the numerical rating scale (NRS) and the visual analogue scale (VAS) as a pain assessment tools among a large cohort of patients who underwent microdiscectomy. . The pain intensity (PI) reduction is a parameter of surgical treatment efficacy. The two most commonly used scales of PI are NRS and VAS. Many studies have shown strong similarities between those two scales, but the direct interchange is difficult.
METHODS
Patients, who underwent microdiscectomy, were prospectively enrolled into the study and assessed using VAS and NRS for the back (NRS-B) and the leg (NRS-L), Short Form of McGill Pain Questionnaire (SF-MPQ) included Pain Rating Index (PRI) and Oswestry Disability Index (ODI) 1 day before and 1 month and 3 months after the procedure.
RESULTS
131 patients were included in the study. NRS-L, NRS-B, VAS, and ODI were significantly lower ( < 0.001) 1 month after microdiscectomy. NRS-L and NRS-B ratings remained at a similar level while VAS and ODI decreased after 3 months. The rate of decline of PI measured by NRS-L correlated statistically significant (rs = 0.366; < 0.001) with ODI 1 month after surgery. Before surgery, the most significant correlation was found between ODI and NRS-L (rs = 0.494; < 0.001), the lowest with NRS-B (rs = 0.319; < 0.001). 3 months after surgery, there was higher correlations between ODI and VAS (rs = 0.634) than NRS-L (rs = 0.265). PRI correlated significantly ( < 0.001) and more stronger with VAS than with NRS-L and NRS-B in every points of assessment.
CONCLUSION
The results showed that PI measurements by NRS-L/NRS-B and VAS mutually correlate and impair functionality evaluated by ODI (convergent validity) but in different modes (differential validity). NRS and VAS are not parallel scales and assess different aspects of pain. The measurement of NRS-L 1 month after microdiscectomy seems to give quick insight into the effectiveness of the procedure.
Topics: Disability Evaluation; Diskectomy; Humans; Lumbar Vertebrae; Pain; Pain Measurement; Treatment Outcome; Visual Analog Scale
PubMed: 35391853
DOI: 10.1155/2022/5337483 -
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... 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 -
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 -
The Journal of the American Academy of... Jul 2022Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP...
INTRODUCTION
Out-of-pocket (OOP) costs for medical and surgical care can result in substantial financial burden for patients and families. Relatively little is known regarding OOP costs for commercially insured patients receiving orthopaedic surgery. The aim of this study is to analyze the trends in OOP costs for common, elective orthopaedic surgeries performed in the hospital inpatient setting.
METHODS
This study used an employer-sponsored insurance claims database to analyze billing data of commercially insured patients who underwent elective orthopaedic surgery between 2014 and 2019. Patients who received single-level anterior cervical diskectomy and fusion (ACDF), single-level posterior lumbar fusion (PLF), total knee arthroplasty (TKA), and total hip arthroplasty (THA) were identified. OOP costs associated with the surgical episode were calculated as the sum of deductible payments, copayments, and coinsurance. Monetary data were adjusted to 2019 dollars. General linear regression, Wilcoxon-Mann-Whitney, and Kruskal-Wallis tests were used for analysis, as appropriate.
RESULTS
In total, 10,225 ACDF, 28,841 PLF, 70,815 THA, and 108,940 TKA patients were analyzed. Most patients in our study sample had preferred provider organization insurance plans (ACDF 70.3%, PLF 66.9%, THA 66.2%, and TKA 67.0%). The mean OOP costs for patients, by procedure, were as follows: ACDF $3,180 (SD = 2,495), PLF $3,166 (SD = 2,529), THA $2,884 (SD = 2,100), and TKA $2,733 (SD = 1,994). Total OOP costs increased significantly from 2014 to 2019 for all procedures (P < 0.0001). Among the insurance plans examined, patients with high-deductible health plans had the highest episodic OOP costs. The ratio of patient contribution (OOP costs) to total insurer contribution (payments from insurers to providers) was 0.07 for ACDF, 0.04 for PLF, 0.07 for THA, and 0.07 for TKA.
CONCLUSION
Among commercially insured patients who underwent elective spinal fusion and major lower extremity joint arthroplasty surgery, OOP costs increased from 2014 to 2019. The OOP costs for elective orthopaedic surgery represent a substantial and increasing financial burden for patients.
Topics: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Diskectomy; Elective Surgical Procedures; Health Expenditures; Humans; Linear Models; Retrospective Studies; Spinal Fusion; Statistics, Nonparametric
PubMed: 35797680
DOI: 10.5435/JAAOS-D-22-00085 -
Turkish Neurosurgery 2023To investigate the effects of a lumbar exercise program after single-level lumbar microdiscectomy on the recurrence of lumbar disc diseases.
AIM
To investigate the effects of a lumbar exercise program after single-level lumbar microdiscectomy on the recurrence of lumbar disc diseases.
MATERIAL AND METHODS
Between 2018 and 2021, 223 patients (104 women, 119 men, median age: 49 years) who received their first corrective surgery for lumbar disc herniation were included in this retrospective study. Their clinical status was evaluated before surgery, early post-surgery, and 6-months after surgery using the Visual Analog Scale (VAS) and Oswestry Disability Index (ODI). Patients were divided into two groups: group A (n=124) included those who regularly participated in the postoperative physical therapy and rehabilitation program for 6 months; group B (n=99) included those who did not regularly participated or did not participate at all in the physical therapy and rehabilitation program. Their compliance to the 6-month physical therapy program (started at our clinic in the 1st postoperative month) and its relation to recurrent lumbar disc hernia at the same level was evaluated.
RESULTS
In group B, 82 patients showed irregular compliance to the physical therapy program and 17 patients did not participate in the physical therapy program. During the 6-month follow-up period, 27 patients developed recurrent disc hernia at the same level (group A, 9 patients; group B, 18 patients) and they accordingly underwent repeat microdiscectomy surgery.
CONCLUSION
Compliance with the postoperative physical therapy program after single-level lumbar microdiscectomy is one of the factors that prevented recurrent disc hernia during the early postoperative period.
Topics: Male; Humans; Female; Middle Aged; Retrospective Studies; Intervertebral Disc Displacement; Diskectomy; Intervertebral Disc Degeneration; Physical Therapy Modalities; Lumbar Vertebrae; Treatment Outcome
PubMed: 36300580
DOI: 10.5137/1019-5149.JTN.40904-22.5 -
BMC Musculoskeletal Disorders Sep 2023In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is...
In recent years, with improved living standards, adolescent obesity has been increasingly studied. The incidence of lumbar disc herniation (LDH) in obese adolescents is increasing yearly. No clinical studies have reported the use of percutaneous endoscopic lumbar discectomy (PELD) in obese adolescent lumbar disc herniation (ALDH) patients. This study evaluated the preliminary surgical outcomes of PELD in obese ALDH patients. Fifty-one ALDH patients underwent single-level PELD surgery between January 2014 and January 2020. Patients were divided into an obese group and a normal group. Patient characteristics and surgical variables were compared between the two groups. The VAS, ODI, and SF-36 scales were used preoperatively and postoperatively to evaluate the clinical efficacy. In this study, 19 patients were included in the obese group, and 28 were included in the normal group. There was no significant difference in age, sex, duration of low back pain, duration of leg pain, or operative level between the obese and normal groups preoperatively. The obese group had a longer operative time (OT) (101.9 ± 9.0 min vs. 84.3 ± 11.0 min, P < 0.001), more fluoroscopy exposures (41.0 ± 5.8 vs. 31.6 ± 7.0, P < 0.001) and a longer time to ambulation (29.9 ± 4.0 vs. 25.0 ± 2.9, p < 0.001) than the normal group. The groups did not significantly differ in complications. The VAS score for back and leg pain and the ODI and SF-36 score for functional status improved significantly postoperatively. The PELD procedure is a safe and feasible method for treating LDH in obese adolescents. Obese ALDH patients require a longer OT, more fluoroscopy exposures and a longer time to get out of bed than normal ALDH patients. However, PELD yields similar clinical outcomes in obese and normal ALDH patients.
Topics: Adolescent; Humans; Diskectomy, Percutaneous; Pediatric Obesity; Intervertebral Disc Displacement; Lumbar Vertebrae; Diskectomy; Low Back Pain
PubMed: 37674144
DOI: 10.1186/s12891-023-06842-8 -
Turkish Neurosurgery 2023To evaluate the safety and efficacy of posterior transdural discectomy for thoracic disc herniation.
AIM
To evaluate the safety and efficacy of posterior transdural discectomy for thoracic disc herniation.
MATERIAL AND METHODS
The medical records of seven patients who underwent posterior transdural discectomy for thoracic disc herniation were retrospectively evaluated.
RESULTS
Between 2012 and 2020, seven patients (five men and two women) who were aged between 17 and 74 years underwent posterior transdural discectomy. Numbness is the most common presenting symptom, and two patients complained of urinary incontinence. T10-11 was the most affected level. All patients underwent at least 6 months of follow-up. There were no postoperative cerebrospinal fluid leaks and neurological complications postoperatively. All patients maintained their baseline neurological status or improved after surgery. No patient had secondary neurological deterioration or need for further surgical treatment.
CONCLUSION
The posterior transdural approach is a safe procedure that should be considered in lateral and paracentral thoracic disc herniations providing a more direct surgical intervention.
Topics: Male; Humans; Female; Adolescent; Young Adult; Adult; Middle Aged; Aged; Intervertebral Disc Displacement; Retrospective Studies; Treatment Outcome; Diskectomy; Cerebrospinal Fluid Leak
PubMed: 37144652
DOI: 10.5137/1019-5149.JTN.42015-22.4 -
BMC Musculoskeletal Disorders May 2023Follow-ups more than 20 years after neck surgery are extremely rare. No previous randomized studies have investigated differences in pain and disability more than 20... (Randomized Controlled Trial)
Randomized Controlled Trial
A more than 20-year follow-up of pain and disability after anterior cervical decompression and fusion surgery for degenerative disc disease and comparisons between two surgical techniques.
BACKGROUND
Follow-ups more than 20 years after neck surgery are extremely rare. No previous randomized studies have investigated differences in pain and disability more than 20 years after ACDF surgery using different techniques. The purpose of this study was to describe pain and functioning more than 20 years after anterior cervical decompression and fusion surgery, and to compare outcomes between the Cloward Procedure and the carbon fiber fusion cage (CIFC).
METHODS
This study is a 20 to 24-year follow-up of a randomized controlled trial. Questionnaires were sent to 64 individuals, at least 20 years after ACDF due to cervical radiculopathy. Fifty individuals (mean age 69, 60% women, 55% CIFC) completed questionnaires. Mean time since surgery was 22.4 years (range 20,5-24). Primary outcomes were neck pain and neck disability index (NDI). Secondary outcomes were frequency and intensity of neck and arm pain, headache, dizziness, self-efficacy, health related quality of life or global outcome. Clinically relevant improvements were defined as 30 mm decrease in pain and a decrease in disability of 20 percentage units. Between-group differences over time were analyzed with mixed design ANOVA and relationships between main outcomes and psychosocial factors were analyzed by Spearman´s rho.
RESULTS
Neck pain and NDI score significantly improved over time (p < .001), with no group differences in primary or secondary outcomes. Eighty-eight per cent of participants experienced improvements or full recovery, 71% (pain) and 41% (NDI) had clinically relevant improvements. Pain and NDI were correlated with lower self-efficacy and quality of life.
CONCLUSION
The results from this study do not support the idea that fusion technique affects long-term outcome of ACDF. Pain and disability improved substantially over time, irrespective of surgical technique. However, the majority of participants reported residual disability not to a negligible extent. Pain and disability were correlated to lower self-efficacy and quality of life.
Topics: Humans; Female; Aged; Male; Treatment Outcome; Follow-Up Studies; Neck Pain; Intervertebral Disc Degeneration; Quality of Life; Cervical Vertebrae; Spinal Fusion; Decompression; Diskectomy
PubMed: 37217867
DOI: 10.1186/s12891-023-06503-w