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Medicina (Kaunas, Lithuania) Dec 2022Background: Surgical incision pain, rebound pain, and recurrence can manifest themselves in different forms of postoperative pain after full endoscopic lumbar discectomy... (Observational Study)
Observational Study
Background: Surgical incision pain, rebound pain, and recurrence can manifest themselves in different forms of postoperative pain after full endoscopic lumbar discectomy (FELD). This study aims to evaluate various postoperative pains after FELD and summarize their characteristics. Methods: Data about the demographic characteristics of patients, pain intensity, and functional assessment results were collected from January 2016 to September 2019. Clinical outcomes including Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, were obtained. Results: A total of 206 patients were enrolled. ODI and VAS of the patients significantly decreased after FELD at 12-month follow-up. A total of 193 (93.7%) patients had mild surgical incision pain after FELD and generally a VAS < 4, and it mostly resolved on its own within 3 days. A total of 12 (5.8%) patients experienced rebound pain, which was typically characterized by pain (mainly leg pain with or without back pain), generally occurring within 2 weeks after FELD and lasting < 3 weeks. The pain levels of rebound pain were equal to or less than those of preoperative pain, and generally scored a VAS of < 6. The recurrence rate was 4.4%. Recurrence often occurs within three months after surgery, with the pain level of the recurrence being greater than or equal to the preoperative pain. Conclusions: Different types of postoperative pain have their own unique characteristics and durations, and treatment options are also distinct. Conservative treatment and analgesia may be indicated for rebound pain and surgical incision pain, but recurrence usually requires surgical treatment.
Topics: Humans; Intervertebral Disc Displacement; Surgical Wound; Treatment Outcome; Lumbar Vertebrae; Diskectomy; Endoscopy; Back Pain; Pain, Postoperative; Retrospective Studies
PubMed: 36557019
DOI: 10.3390/medicina58121817 -
Medicine Apr 2017Cervical disc replacement (CDR) has been developed as an alternative surgical procedure to anterior cervical discectomy and fusion (ACDF) for the treatment of... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Cervical disc replacement (CDR) has been developed as an alternative surgical procedure to anterior cervical discectomy and fusion (ACDF) for the treatment of single-level cervical degenerative disc disease. However, patients with multilevel cervical degenerative disc disease (MCDDD) are common in our clinic. Multilevel CDR is less established compared with multilevel ACDF. This study aims to compare the outcomes and evaluate safety and efficacy of CDR versus ACDF for the treatment of MCDDD.
METHODS
A meta-analysis was performed for articles published up until August 2016. Randomized controlled trials (RCTs) and prospective comparative studies associated with the use of CDR versus ACDF for the treatment of MCDDD were included in the current study. Two reviewers independently screened the articles and data following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement.
RESULTS
Seven studies with 702 enrolled patients suffering from MCDDD were retrieved. Patients who underwent CDR had similar operative times, blood loss, Neck Disability Index (NDI) scores, and Visual Analog Scale (VAS) scores compared to patients who underwent ACDF. Patients who underwent CDR had greater overall motion of the cervical spine and the operated levels than patients who underwent ACDF. Patients who underwent CDR also had lower rates of adjacent segment degeneration (ASD). The rate of adverse events was significantly lower in the CDR group.
CONCLUSION
CDR may be a safe and effective surgical strategy for the treatment of MCDDD. However, there is insufficient evidence to draw a strong conclusion due to relatively low-quality evidence. Future long-term, multicenter, randomized, and controlled studies are needed to validate the safety and efficacy of multilevel CDR.
Topics: Cervical Vertebrae; Diskectomy; Humans; Intervertebral Disc Degeneration; Randomized Controlled Trials as Topic; Spinal Fusion
PubMed: 28422837
DOI: 10.1097/MD.0000000000006503 -
Medicine May 2016To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical... (Meta-Analysis)
Meta-Analysis Review
To investigate the outcomes and reliability of hybrid surgery (HS) versus anterior cervical discectomy and fusion (ACDF) for the treatment of multilevel cervical spondylosis and disc diseases.Hybrid surgery, combining cervical disc arthroplasty (CDA) with fusion, is a novel treatment to multilevel cervical degenerated disc disease in recent years. However, the effect and reliability of HS are still unclear compared with ACDF.To investigate the studies of HS versus ACDF in patients with multilevel cervical disease, electronic databases (Medline, Embase, Pubmed, Cochrane library, and Cochrane Central Register of Controlled Trials) were searched. Studies were included when they compared HS with ACDF and reported at least one of the following outcomes: functionality, neck pain, arm pain, cervical range of motion (ROM), quality of life, and incidence of complications. No language restrictions were used. Two authors independently assessed the methodological quality of included studies and extracted the relevant data.Seven clinical controlled trials were included in this study. Two trials were prospective and the other 5 were retrospective. The results of the meta-analysis indicated that HS achieved better recovery of NDI score (P = 0.038) and similar recovery of VAS score (P = 0.058) compared with ACDF at 2 years follow-up. Moreover, the total cervical ROM (C2-C7) after HS was preserved significantly more than the cervical ROM after ACDF (P = 0.000) at 2 years follow-up. Notably, the compensatory increase of the ROM of superior and inferior adjacent segments was significant in ACDF groups at 2-year follow-up (P < 0.01), compared with HS.The results demonstrate that HS provides equivalent outcomes and functional recovery for cervical disc diseases, and significantly better preservation of cervical ROM compared with ACDF in 2-year follow-up. This suggests the HS is an effective alternative invention for the treatment of multilevel cervical spondylosis to preserve cervical ROM and reduce the risk of adjacent disc degeneration. Nonetheless, more well-designed studies with large groups of patients are required to provide further evidence for the benefit and reliability of HS for the treatment of cervical disk diseases.
Topics: Clinical Trials as Topic; Diskectomy; Humans; Neck Pain; Postoperative Complications; Quality of Life; Range of Motion, Articular; Spinal Diseases
PubMed: 27227922
DOI: 10.1097/MD.0000000000003621 -
European Spine Journal : Official... Jun 2001This review presents the history of chemonucleolysis, the techniques, indications, contraindications, and complications. Presenting an historical overview and comparison... (Comparative Study)
Comparative Study Review
This review presents the history of chemonucleolysis, the techniques, indications, contraindications, and complications. Presenting an historical overview and comparison of success rates with surgical discectomy may provide a fresh understanding of the controversy surrounding chemonucleolysis and establish its efficacy in relation to more invasive treatments. A review of the literature from 1973 through 1998 for chemonucleolysis, open discectomy, and microdiscectomy provided published success rates for these procedures, and a mean rate with standard deviation was determined. In the experience and opinion of the authors, chemonucleolysis remains a viable alternative for patients who have exhausted all conservative means of treatment. Proper patient selection leads to success rates comparable to open discectomy and microdiscectomy.
Topics: Chymopapain; Contraindications; Diskectomy; Humans; Intervertebral Disc Chemolysis; Laser Therapy; Microsurgery; Orthopedics; Patient Selection
PubMed: 11469729
DOI: 10.1007/s005860000234 -
Medicina (Kaunas, Lithuania) May 2022: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery... (Review)
Review
: The use of minimally invasive retractor systems has significantly decreased the amount of tissue dissection and blood loss, and the duration of post-operative recovery after far-lateral disc herniations (FLDH). In this technical note, the technique of docking the tubular retractor on the caudal transverse process is described for an efficient approach with a decreased need for manipulation of the exiting nerve root. : The case reported is that of a woman affected by a right-sided FLDH at the L4-5 level causing an L4 radiculopathy with weakness and numbness. A review of the literature for FLDH regarding the key anatomy used during a far lateral approach was also performed. : The patient showed a significant improvement of her dorsiflexion weakness and radiating leg pain at her 2-week and 5-week post-operative visits, and at a 6-month follow-up she had near-complete relief of her symptoms, including resolution of foot numbness. Prior techniques for tubular microdiscectomy for FLDH report docking on the facet joint, pars interarticularis, and the cranial transverse process. : This technical note details that the utility of docking a tubular retractor at the caudal transverse process improves upon already established techniques for minimally invasive tubular discectomy for FLDH.
Topics: Diskectomy; Female; Humans; Hypesthesia; Intervertebral Disc Displacement; Lumbar Vertebrae; Microsurgery
PubMed: 35630057
DOI: 10.3390/medicina58050640 -
BMC Musculoskeletal Disorders Sep 2022A symptomatic postoperative pseudocyst (PP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to worse symptoms. Some minority...
BACKGROUND
A symptomatic postoperative pseudocyst (PP) is a cystic lesion that is formed in the operation area of the intervertebral disc, leading to worse symptoms. Some minority patients who developed PP experienced rapidly aggravating symptoms and could not be treated by any kind of conservative treatment. However, no clinical studies have evaluated the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after full-endoscopic lumbar discectomy (FELD). This study aimed to demonstrate the clinical characteristics and surgical strategies of symptomatic PP requiring a revision surgery after FELD.
METHODS
We retrospectively analyzed the data of patients who received FELD revision surgeries due to symptomatic PP formation between January 2016 and December 2021. Common characteristics, time intervals of symptom recurrence and revision surgery, strategies for conservative treatment and revision surgery, operative time, imaging characteristics, numeric rating scale (NRS) score, Oswestry disability index (ODI) and overall outcome rating based on modified MacNab criteria were analyzed.
RESULTS
Fourteen patients (males = 10, females = 4), with a mean age of 24.4 years, were enrolled. The mean time intervals of symptom recurrence and revision surgery were 43.5 and 18.9 days respectively. While the patients were conservatively managed with analgesics and physical therapy, pain persisted or progressively worsened. In comparison to the initial herniated disc, the PP was larger in 11 cases, and up- or down-migrated in four cases. The PP location included the lateral recess (n = 12), foraminal (n = 1), and centrolateral (n = 1) zones. One of the two cases treated by percutaneous aspiration (PA) was eventually treated by FELD as pain was not relieved. Follow-ups revealed an improved mean NRS score from 7.1 to 1.4, mean ODI from 68.6 to 7.9% and promising overall surgical outcomes.
CONCLUSIONS
The progressively severe pain experienced due to PP might be a result of its enlargement or migration to the lateral recess and foraminal zones. As complete removal of capsule is the goal, we recommend FELD instead of PA.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Pain; Reoperation; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 36057592
DOI: 10.1186/s12891-022-05791-y -
Neurologia Medico-chirurgica Jan 2020For full-endoscopic lumbar discectomy, operating costs are also important because expensive equipment are necessary. We surveyed the operating costs of surgical...
For full-endoscopic lumbar discectomy, operating costs are also important because expensive equipment are necessary. We surveyed the operating costs of surgical equipment necessary for full-endoscopic surgery together with surgical procedure reimbursement fees. A total of 295 cases of full-endoscopic surgery via a transforaminal approach were retrospectively analyzed. We calculated the frequency of damage and the unit purchase price of devices such as endoscopes, and surgical instruments such as grasping forceps for nucleotomy, high-speed drill bar, and bipolar forceps, and examined the operating costs in Japanese yen against the procedure fee per case. Endoscope breakage occurred seven times, and a payment of ¥760,000 was necessary for trade-in and purchase of a new endoscope. The total breakage number of grasping forceps was 58, and the purchase price per unit was ¥116,000. Therefore, a total of ¥12,020,000 was required for the 295 cases, and the calculated operating cost that accompanies equipment breakage was ¥40,000 per case. In addition, about ¥118,000 was required for disposable bipolar forceps and high-speed drill bar to be used intraoperatively for each case. Thus, for one case it is calculated that total ¥158,000 is utilized for equipment from the surgical reimbursement fee per case specified by the Japanese Ministry of Health being ¥303,900. Minimally invasive procedures provide great benefit to patients; however, the eventual contribution to hospital profits is small and may not be sufficient. To resolve this issue, the cost of surgical equipment should be lowered and/or the surgical reimbursement fee of the full-endoscopic surgery should be raised.
Topics: Diskectomy; Endoscopes; Endoscopy; Equipment Failure; Humans; Insurance, Health, Reimbursement; Intervertebral Disc Displacement; Japan; Lumbar Vertebrae; Surgical Equipment; Surgical Instruments
PubMed: 31619601
DOI: 10.2176/nmc.oa.2019-0139 -
Neurologia Medico-chirurgica Jul 2023This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation...
This study aims to compare the outcomes of interlaminar and transforaminal approaches for full-endoscopic discectomy (FED) for treating L4/5 lumbar disc herniation (LDH).A retrospective study of patients with L4/5 LDH treated with interlaminar endoscopic lumbar discectomy (IELD, n = 19) or transforaminal endoscopic lumbar discectomy (TELD, n = 105) was conducted. Patient background, radiological findings, and operative data were collected. Oswestry Disability Index (ODI) and European Quality of Life-5 Dimension (EQ-5D) scores were recorded preoperatively and 1 and 2 years postoperatively.Although ODI and EQ-5D scores 1 and 2 years postoperatively improved statistically in the IELD and TELD groups, there were no statistical differences between the groups. IELD was predominantly performed in patients who were taller and heavier. The mean operative times and the frequency of laminectomy for IELD and TELD were 67.2 and 44.6 min and 63.2 and 17.1%, respectively (P < 0.001). The radiological findings showed that the concave configuration of the L4 lamina, interlaminar space width, and foraminal width were statistically different between the groups. There were no complications in either of the groups. Reoperation was required for recurrence in two and five patients in the IELD and TELD groups (P = 0.29), respectively.Operative outcomes were identical between the two groups. Although the operative time was longer in the IELD group, both approaches were safely and effectively performed. Depending on the patient's physique and preoperative radiological findings, the more suitable approach for L4/5 LDH should be chosen.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Quality of Life; Diskectomy, Percutaneous; Treatment Outcome; Endoscopy; Diskectomy; Lumbar Vertebrae
PubMed: 37164700
DOI: 10.2176/jns-nmc.2022-0357 -
Journal of Orthopaedic Surgery and... Mar 2022Advances in minimally invasive surgery have expanded the indications for interlaminar full-endoscopic discectomy. Although the clinical outcomes for this approach may be...
Comparative study of the efficacy and safety of minimally invasive interlaminar full-endoscopic discectomy versus conventional microscopic discectomy in single-level lumbar herniated intervertebral disc (ENDO-F Trial): a multicenter, prospective, randomized controlled trial protocol.
BACKGROUND
Advances in minimally invasive surgery have expanded the indications for interlaminar full-endoscopic discectomy. Although the clinical outcomes for this approach may be equivalent to those of conventional microscopic discectomy, the supporting evidence is still based on small, single-center, prospective, and retrospective studies. Therefore, a multicenter randomized controlled trial is warranted.
METHODS
This will be a prospective, multicenter, randomized controlled trial comparing the efficacy and safety of interlaminar full-endoscopic discectomy to those of conventional microscopic discectomy. The trial will enroll 100 participants with a lumbar disc herniation, 50 in each group. The primary outcome will be the Oswestry Disability Index (ODI) score at 12 months post-surgery. Secondary outcomes will be back and leg pain (visual analog scale); the ODI; the EuroQol-5-dimension score; patient satisfaction; and walking distance/time and time to return to daily activities post-surgery. Surgical outcomes will include postoperative drainage, operative time, duration of hospital stay, postoperative creatine kinase level as an indicator of muscle injury, and postoperative scarring. Postoperative magnetic resonance imaging, computed tomography, and simple radiography will be performed to evaluate radiographic outcomes between the two surgical approaches. Surgery-related complications and adverse effects will be evaluated as safety outcomes. A single assessor at each participating hospital, blinded to group allocation, will assess the enrolled participants at baseline, at 2 weeks, and at 3, 6, and 12 months postoperatively.
DISCUSSION
This trial is designed to determine whether interlaminar full-endoscopic discectomy is clinically comparable to microscopic discectomy to treat lumbar disc herniations. All efforts will be made to reduce bias, including adequate sample size, blinded analyses, and multicenter prospective registration. The outcomes will inform practice, providing the evidence needed for using interlaminar full-endoscopic over microscopic discectomy by confirming the potential of this technique to improve patient satisfaction and clinical outcomes.
TRIAL REGISTRATION
Clinical Research Information Service; cris.nih.go.kr. (KCT0006277); protocol version (v1, June 8, 2021).
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Lumbar Vertebrae; Multicenter Studies as Topic; Prospective Studies; Randomized Controlled Trials as Topic; Retrospective Studies; Treatment Outcome
PubMed: 35346274
DOI: 10.1186/s13018-022-03052-1 -
International Journal of Surgery... Jul 2016The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and... (Comparative Study)
Comparative Study Meta-Analysis Review
PURPOSE
The purpose of the study is to perform a systematic review and meta-analysis to evaluate the clinical results of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for the treatment of lumbar disc herniation (LDH).
METHODS
Randomized controlled trials or non-randomized controlled trials published from the time when databases were built to March 2016 that compared the clinical effectiveness of PELD and OLM surgical approaches for the treatment of LDH were acquired by a comprehensive search in four electronic databases (PubMed, EMBASE, Web of Science and Cochrane library). A total of 7 studies (1389 patients) were included in this systematic review and meta-analysis. Pooled mean differences (MD) and odds ratios (OR) and with 95% CIs were calculated for the outcomes.
RESULT
The results showed that there were no statistically between the PELD group and OLM group in terms of preoperative VAS-BP score (WMD = 0.03; 95% CI: -0.99 to 1.05; P = 0.95), postoperative VAS-BP score (WMD = -0.56; 95% CI: -1.43 to 0.31; P = 0.21), postoperative ODI (WMD = -0.98; 95% CI: -4.96 to 3.00; P = 0.63), complication rate (OR = 1.79; 95% CI: 0.95 to 3.37; P = 0.07) or reoperation rate (OR = 1.44; 95% CI: 0.94 to 2.20; P = 0.09). PELD group was associated with shorter operation time (WMD = -12.83; 95% CI: -24.79 to -0.87; P = 0.04) and hospital stay (WMD = -5.49; 95% CI: -8.63 to -2.35; P = 0.0006).
CONCLUSION
The existing evidence indicate that no superiority exists between the two surgical approaches for the treatment of LDH in terms of functional outcome, complication rate and reoperation rate, in spite of that PELD surgical group can achieve shorter operation time and hospital stay than OLM surgical group.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Treatment Outcome
PubMed: 27260312
DOI: 10.1016/j.ijsu.2016.05.061