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Drug Design, Development and Therapy 2024Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC)...
Determining the Maximum Tolerable Concentration of Ropivacaine to Maintain Sensation of the Nerve Root in Percutaneous Endoscopic Transforaminal Lumbar Discectomy: Can Epidural Anaesthesia Achieve Pain-Tactile Separation Block to Avoid Nerve Injury?
INTRODUCTION
Nerve injury is a serious complication of percutaneous endoscopic transforaminal lumbar discectomy due to nerve root contact. The maximum tolerable concentration (MTC) of ropivacaine concentration for epidural anaesthesia, is defined as the concentration that minimises pain while preserving the sensation of the nerve roots. This distinct advantage allows the patient to provide feedback to the surgeon when the nerve roots are contacted.
METHODS
We used a biased-coin design to determine the MTC, which was estimated by the 10% effective concentration (EC), ie, the concentration at which 10% of patients lost sensation in the nerve roots. The determinant for positive response was lack of sensory feedback upon contact with the nerve root, and the feedback from occurrence of sensations in the innervation area upon contact with the nerve root was defined as a negative response. Primary outcome was the response from contact nerve root. Secondary outcomes were the type and number of statements of negative response and each patient's pain score during surgery.
RESULTS
Fifty-four patients were included in this study. The EC was 0.434% (95% CI: 0.410%, 0.440%) using isotonic regression in comparison with 0.431% (95% CI: 0.399%, 0.444%) using probit regression. Three type statements of negative response were reported including "tactile sensation", radiculalgia, and numbness.
CONCLUSION
The MTC of ropivacaine used for epidural anaesthesia was 0.434% to avoid nerve injury in percutaneous endoscopic transforaminal lumbar discectomy.
Topics: Ropivacaine; Humans; Male; Middle Aged; Female; Lumbar Vertebrae; Adult; Anesthetics, Local; Anesthesia, Epidural; Diskectomy, Percutaneous; Endoscopy; Spinal Nerve Roots; Dose-Response Relationship, Drug; Sensation; Aged
PubMed: 38915867
DOI: 10.2147/DDDT.S451980 -
Journal of Pain Research 2024Previous studies highlight paraspinal muscles' significance in spinal stability. This study aims to assess paraspinal muscle predictiveness for postoperative recurrent...
PURPOSE
Previous studies highlight paraspinal muscles' significance in spinal stability. This study aims to assess paraspinal muscle predictiveness for postoperative recurrent lumbar disc herniation (PRLDH) after lumbar disc herniation patients undergo percutaneous endoscopic transforaminal discectomy (PETD).
PATIENTS AND METHODS
Retrospectively collected data from 232 patients undergoing PETD treatment at our institution between January 2020 and January 2023, randomly allocated into training (60%) and validation (40%) groups. Utilizing Lasso regression and multivariable logistic regression, independent risk factors were identified in the training set to construct a Nomogram model. Internal validation employed Enhanced Bootstrap, with Area Under the ROC Curve (AUC) assessing accuracy. Calibration was evaluated through calibration curves and the Hosmer-Lemeshow goodness-of-fit test. Decision curve analysis (DCA) and clinical impact curve (CIC) were employed for clinical utility analysis.
RESULTS
Diabetes, Modic changes, and ipsilesional multifidus muscle skeletal muscle index (SMI) were independent predictive factors for PRLDH following PETD (<0.05). Developed Nomogram model based on selected predictors, uploaded to a web page. AUC for training: 0.921 (95% CI 0.872-0.970), validation: 0.900 (95% CI 0.828-0.972), respectively. The Hosmer-Lemeshow test yielded =5.638/6.259, =0.688/0.618, and calibration curves exhibited good fit between observed and predicted values. DCA and CIC demonstrate clinical net benefit for both models at risk thresholds of 0.02-1.00 and 0.02-0.80.
CONCLUSION
The Nomogram predictive model developed based on paraspinal muscle parameters in this study demonstrates excellent predictive capability and aids in personalized risk assessment for PRLDH following PETD.
PubMed: 38894861
DOI: 10.2147/JPR.S459846 -
International Wound Journal Jun 2024
Topics: Humans; Surgical Wound Infection; Risk Factors; Male; Diskectomy, Percutaneous; Middle Aged; Female; Adult; Lumbar Vertebrae; Endoscopy; Aged; Retrospective Studies
PubMed: 38887987
DOI: 10.1111/iwj.14939 -
American Journal of Translational... 2024To compare the surgical metrics, improvement of functional scores, and clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous...
OBJECTIVE
To compare the surgical metrics, improvement of functional scores, and clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) and to analyze the independent risk factors affecting the therapeutic efficacy of PETD.
METHODS
The clinical data of LDH (lumbar disc herniation) patients who underwent treatment in Shaanxi Provincial Nuclear Industry 215 Hospital from May 2020 to May 2022 were retrospectively collected, including 70 PEID cases and 74 PETD cases. The two groups were compared in terms of surgical indexes, such as operation time and bleeding volume, as well as changes in functional scores, such as preoperative and postoperative Visual Analogue Scale (VAS) scores and Oswestry Disability Index (ODI). The clinical efficacy was evaluated according to the Macnab criteria, and logistic regression analysis was performed to determine the independent influencing factors of the treatment efficacy of PETD.
RESULTS
The differences between the two surgical groups were statistically significant in terms of operation time (P<0.001), bleeding (P=0.005), and C-arm X-ray exposure times (P<0.001), and the above indexes were higher in the PETD group; however, there were no statistical differences in terms of improvement in functional scores (P>0.05) and clinical efficacy (P>0.05) between the two groups. BMI≥25 kg/m (P=0.001), severe disc degeneration (P=0.003), and operation time ≥60 min (P=0.003), severe disc degeneration (P=0.003), and operation time ≥60 min (P=0.036) were independent risk factors for the outcome of PETD.
CONCLUSION
The clinical effectiveness of PEID and PETD in treating LDH is comparable, and each has its own advantages. While PETD is more technically demanding, it does not yield superior results. Obesity, severe disc degeneration, and prolonged surgery are risk factors for the treatment efficacy of PETD.
PubMed: 38883385
DOI: 10.62347/HFAP6601 -
BMC Musculoskeletal Disorders Jun 2024Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of... (Comparative Study)
Comparative Study
BACKGROUND
Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of patients with ULDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) compared with those with lower LDH.
METHODS
60 patients with ULDH or L4-L5 LDH treated with PTED between May 2016 and October 2021. MacNab criteria, visual analog scale (VAS) of back pain and leg pain, and Japanese Orthopedic Association (JOA) were evaluated before and after surgery.
RESULTS
In the L1-L3 group, 59.1% of the patients had a positive femoral nerve tension test, and 81.8% of the patients had a sensory deficit. Both groups showed significant improvements in VAS scores for low back and leg pain, and JOA scores postoperatively. No significant differences in the degree of improvement were observed between the two groups. The excellent/good rate was 81.8% in the L1-L3 group and 84.2% in the L4-L5 group, showing no significant difference.
CONCLUSION
PTED has comparable efficacy in treating ULDH as it does in treating lower LDH, it is a safe and effective treatment method for ULDH.
Topics: Humans; Intervertebral Disc Displacement; Male; Diskectomy, Percutaneous; Female; Lumbar Vertebrae; Middle Aged; Adult; Treatment Outcome; Endoscopy; Retrospective Studies; Pain Measurement; Aged
PubMed: 38879478
DOI: 10.1186/s12891-024-07588-7 -
International Journal of Surgery Case... Jul 2024Percutaneous endoscopic lumbar discectomy (PELD) is increasingly being utilized to treat patients with lumbar disc herniation. PELD is unique in that it uses a single...
Contrast enhancing epidural fluid accumulation after percutaneous endoscopic lumbar discectomy: A case report of recurrent disc herniation within pseudocyst secondary to irrigation fluid.
INTRODUCTION
Percutaneous endoscopic lumbar discectomy (PELD) is increasingly being utilized to treat patients with lumbar disc herniation. PELD is unique in that it uses a single working port endoscope with constant irrigation of the surgical field to visualize pathology. The current report is of a case of postoperative epidural irrigation fluid accumulation presenting as peripherally enhancing epidural lesions, masking an underlying re-herniation.
PRESENTATION OF CASE
A patient with a Lumbar 5-Sacral 1 level disc herniation presenting with radiculopathy was treated using PELD. Following the operation, the patient experienced recurrent pain, prompting a repeat MRI of the lumbar spine. Multiple ring-enhancing lesions within the epidural space were observed, creating diagnostic dilemmas. The differential diagnoses included epidural abscess, pseudomeningocele from unintended durotomy, epidural hematoma, or trapped epidural fluid collection presenting as a pseudocyst with or without recurrent disc herniation. A repeat endoscopic discectomy was performed to confirm the diagnosis of pseudocyst, revealing a recurrent disc herniation.
DISCUSSION
Pseudocysts are not an uncommon complication of PELD, typically believed to be due to an inflammatory response to disc fragments. However, in this case, the epidural fluid collection was likely the result of trapped irrigation fluid from continuous irrigation during the procedure, which masked an underlying re-herniation on imaging.
CONCLUSION
With the increasing utilization of PELD, it is important to acknowledge unique complications such as fluid accumulation from irrigation within the epidural space. Fluid accumulation can lead to contrast-enhancing pseudocyst formation, which can theoretically lead to mass effect or increased intracranial and intraspinal pressure and may mask additional underlying pathology.
PubMed: 38875830
DOI: 10.1016/j.ijscr.2024.109884 -
Journal of Orthopaedic Surgery and... Jun 2024Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated efficacy in alleviating leg pain among patients with lumbar disc herniation. Nonetheless, residual back...
BACKGROUND
Percutaneous endoscopic lumbar discectomy (PELD) has demonstrated efficacy in alleviating leg pain among patients with lumbar disc herniation. Nonetheless, residual back pain persists as a troubling issue for surgeons following the procedure. In the treatment of discogenic back pain, sinuvertebral nerve radiofrequency ablation has shown promising results. Nevertheless, the potential benefit of simultaneously implementing sinuvertebral nerve radiofrequency ablation during PELD surgery to address residual back pain has not been thoroughly investigated in current literature.
METHODS
This retrospective study reviewed Lumbar disc herniation (LDH) patients with low back pain who underwent combined PELD and sinuvertebral nerve ablation in our department between January 2021 and September 2023. Residual low back pain post-surgery was assessed and compared with existing literature.
RESULTS
A total of 80 patients, including 53 males and 27 females, were included in the study. Following surgical intervention, patients demonstrated remarkable improvements in pain and functional parameters. One month post-operatively, the VAS score for low back pain exhibited a 75% reduction (6.45 ± 1.3 to 1.61 ± 1.67), while the VAS score for leg pain decreased by 85% (7.89 ± 1.15 to 1.18 ± 1.26). Notably, the JOA score increased from 12.89 ± 5.48 to 25.35 ± 4.96, and the ODI score decreased form 59.48 ± 9.58 to 20.3 ± 5.37. These improvements were sustained at three months post-operatively. According to the modified Mac Nab criteria, the excellent and good rate was 88.75%. Residual low back pain is observed to be comparatively reduced compared to the findings documented in earlier literature.
CONCLUSION
The combination of percutaneous endoscopic lumbar discectomy and sinuvertebral nerve ablation demonstrates effective improvement in low back pain for LDH patients.
Topics: Humans; Female; Male; Intervertebral Disc Displacement; Low Back Pain; Diskectomy, Percutaneous; Retrospective Studies; Adult; Middle Aged; Lumbar Vertebrae; Endoscopy; Treatment Outcome
PubMed: 38849922
DOI: 10.1186/s13018-024-04831-8 -
BMC Surgery Jun 2024The objective of this study is to evaluate and compare the surgical outcomes and complications of Percutaneous Endoscopic Lumbar Decompression (PELD) and traditional... (Comparative Study)
Comparative Study
OBJECTIVE
The objective of this study is to evaluate and compare the surgical outcomes and complications of Percutaneous Endoscopic Lumbar Decompression (PELD) and traditional revision surgery in treating symptomatic Adjacent Segment Degeneration (ASD). This comparison aims to delineate the advantages and disadvantages of these methods, assisting spine surgeons in making informed surgical decisions.
METHODS
66 patients with symptomatic ASD who failed conservative treatment for more than 1 month and received repeated lumbar surgery were retrospectively collected in the study from January 2015 to November 2018, with the average age of 65.86 ± 11.04 years old. According to the type of surgery they received, all the patients were divided in 2 groups, including 32 patients replaced the prior rod in Group A and 34 patients received PELD at the adjacent level in Group B. Patients were followed up routinely and received clinical and radiological evaluation at 3, 6, 12 months and yearly postoperatively. Complications and hospital costs were recorded through chart reviews.
RESULTS
The majority of patients experienced positive surgical outcomes. However, three cases encountered complications. Notably, Group B patients demonstrated superior pain relief and improved postoperative functional scores throughout the follow-up period, alongside reduced hospital costs (P < 0.05). Additionally, significant reductions in average operative time, blood loss, and hospital stay were observed in Group B (P < 0.05). Notwithstanding these benefits, three patients in Group B experienced disc re-herniation and underwent subsequent revision surgeries.
CONCLUSIONS
While PELD offers several advantages over traditional revision surgery, such as reduced operative time, blood loss, and hospital stay, it also presents a higher likelihood of requiring subsequent revision surgeries. Future studies involving a larger cohort and extended follow-up periods are essential to fully assess the relative benefits and drawbacks of these surgical approaches for ASD.
Topics: Humans; Male; Female; Lumbar Vertebrae; Decompression, Surgical; Reoperation; Retrospective Studies; Aged; Middle Aged; Endoscopy; Treatment Outcome; Intervertebral Disc Degeneration; Postoperative Complications
PubMed: 38844909
DOI: 10.1186/s12893-024-02470-8 -
BMC Musculoskeletal Disorders May 2024To compare the clinical and radiological outcomes of limited discectomy (LD) and aggressive discectomy (AD) performed via spinal endoscopy using the transforaminal... (Comparative Study)
Comparative Study
OBJECTIVE
To compare the clinical and radiological outcomes of limited discectomy (LD) and aggressive discectomy (AD) performed via spinal endoscopy using the transforaminal approach in patients with lumbar disc herniation(LDH) METHODS: We conducted a retrospective review of patients who underwent percutaneous endoscopic transforaminal discectomy (PETD) at the L4-L5 lumbar spine segments in our department from January 2017 to December 2020. The follow-up period extended to 24 months postoperatively. Patients were categorized into the LD and AD groups based on the extent of intraoperative disc removal. We retrospectively collected and analyzed clinical and radiological data.
RESULTS
The study followed 65 patients, with 36 in the LD group and 29 in the AD group. No statistically significant differences were noted in recurrence rates, the excellent and good Macnab rates, preoperative Disc Height Index (DHI), and preoperative Modic changes between the groups (P >0.05). However, significant differences were observed in operation duration, postoperative DHI and postoperative Modic change (P<0.05). No significant differences in Visual Analog Scale (VAS) and Oswestry Disability Index (ODI) scores were detected between the groups preoperatively, or one and two years postoperatively (P>0.05). Nevertheless, notable differences in VAS and ODI scores were present one month postoperatively (P<0.05).
CONCLUSION
As a conventional surgical method for treating LDH, PETD can achieve satisfactory clinical results in both LD and AD, with no significant variance in recurrence rates. However, AD is associated with longer operation times, and greater postoperative reductions in DHI and greater postoperative Modic changes compared to LD.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Male; Female; Lumbar Vertebrae; Middle Aged; Adult; Endoscopy; Treatment Outcome; Diskectomy, Percutaneous; Follow-Up Studies; Recurrence
PubMed: 38807128
DOI: 10.1186/s12891-024-07498-8 -
Asian Journal of Surgery May 2024
PubMed: 38797589
DOI: 10.1016/j.asjsur.2024.05.067