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Bioscience Reports Feb 2019We searched several databases from the times of their inception to 20 December 2018. Randomized controlled trials and cohort studies that compared percutaneous... (Meta-Analysis)
Meta-Analysis
We searched several databases from the times of their inception to 20 December 2018. Randomized controlled trials and cohort studies that compared percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) were identified. We used a random-effects model to calculate the relative risks (RRs) of, and standardized mean differences (SMDs) between the two techniques, with 95% confidence intervals (CIs). Twenty-six studies with 3294 patients were included in the final analysis. Compared with PEID, PETD reduced the short-term (SMD -0.68; 95% CI -1.01, -0.34; =0.000) and long-term (SMD -0.47; 95% CI -0.82, -0.12; =0.000) visual analog scale scores, blood loss (SMD -4.75; 95% CI -5.80, -3.71; =0.000), duration of hospital stay (SMD -1.86; 95% CI -2.36, -1.37; =0.000), and length of incision (SMD -3.93; 95% CI -5.23, -2.62; =0.000). However, PEID was associated with a lower recurrence rate (=0.035) and a shorter operative time (=0.014). PETD and PEID afforded comparable excellent- and good-quality data, long- and short-term Oswestry disability index (ODI) scores, and complication rates. PETD treated lumbar disc herniation (LDH) more effectively than PEID. Although PETD required a longer operative time, PETD was as safe as PEID, and was associated with less blood loss, a shorter hospital stay, and a shorter incision. PETD is the best option for patients with LDH.
Topics: Adult; Aged; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Laminectomy; Length of Stay; Lumbar Vertebrae; Middle Aged; Postoperative Complications
PubMed: 30705086
DOI: 10.1042/BSR20181866 -
The Spine Journal : Official Journal of... Jul 2023Percutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade... (Randomized Controlled Trial)
Randomized Controlled Trial
Effectiveness and safety of intrathecal morphine for percutaneous endoscopic lumbar discectomy under low-dose ropivacaine: a prospective, randomized, double-blind clinical trial.
BACKGROUND CONTEXT
Percutaneous endoscopic lumbar discectomy (PELD) is a surgical setting that requires minimal motor impairment. Low-dose spinal ropivacaine induces little motor blockade and could be ideal for maintaining safety of PELD, but its analgesic efficacy is questionable. An adjunct analgesic approach is needed to maximize the benefits of low-dose spinal ropivacaine for PELD.
PURPOSE
This study aimed to explore the effectiveness and safety of 100 µg intrathecal morphine (ITM) as an adjuvant analgesic method for PELD under low-dose spinal ropivacaine.
STUDY DESIGN
A double-blind, randomized, placebo-controlled trial.
TRIAL REGISTRATION
ChiCTR2000039842 (www.chictr.org.cn).
SAMPLE
Ninety patients scheduled for elective single-level PELD under low-dose spinal ropivacaine.
OUTCOME MEASURES
The primary outcome was the overall intraoperative visual analogue scale (VAS) score for pain. Secondary outcomes were intraoperative VAS scores assessed at multiple timepoints; intraoperative rescue analgesic requirement; postoperative VAS scores; disability scale; patients' satisfaction with anesthesia; adverse events; and radiographic outcomes.
METHODS
Patients were randomized to receive low-dose ropivacaine spinal anesthesia with (ITM group, n=45) or without (control group, n=45) 100 µg ITM.
RESULTS
The overall intraoperative VAS score in the ITM group was significantly lower than that in the control group (0 [0, 1] vs 2 [1, 3], p<.001). During operation, the VAS scores at cannula insertion, 30 minutes after insertion, 60 minutes after insertion, and 120 minutes after insertion were all significantly lower in the ITM group (all p<.05). Less patients in the ITM group required rescue analgesia during operation compared with those in the control group (14% vs 42%, p= .003). The VAS score for back pain in the ITM group was lower than that in the control group at 1 hour, 12 hours, and 24 hours postoperatively. Besides, the satisfaction score in the ITM group was significantly higher than that in the control group (p=.017). For adverse events, 8/43 of ITM and 1/44 of control participants experienced pruritus (p=.014), with a relative risk (95% confidence interval) of 8.37 (1.09-64.16). The incidence of other adverse events was similar between the two groups. Of note, respiratory depression occurred in one ITM-treated patient.
CONCLUSION
The addition of 100 µg ITM to low-dose ropivacaine appears to be effective in analgesia without compromised motor function for PELD; however, ITM increased the risk of pruritus and clinicians should be vigilant about its potential risk of respiratory depression.
Topics: Humans; Ropivacaine; Morphine; Analgesics, Opioid; Diskectomy, Percutaneous; Prospective Studies; Pain, Postoperative; Injections, Spinal; Intervertebral Disc Displacement; Lumbar Vertebrae; Analgesics; Diskectomy; Pruritus; Respiratory Insufficiency; Treatment Outcome; Double-Blind Method
PubMed: 36931566
DOI: 10.1016/j.spinee.2023.03.001 -
Annals of Palliative Medicine Nov 2020The aim of the present study was to report a new technique for electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy and...
BACKGROUND
The aim of the present study was to report a new technique for electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy and to evaluate the efficacy of this technology in the treatment of lumbar disc herniation (LDH).
METHODS
This is a retrospective study. Seventeen patients who underwent electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy in our department from September to November 2018 were included in the study. Patients' hospital charts, magnetic resonance imaging results, surgical data and follow-up records were reviewed. Outcomes were assessed by visual analog scale (VAS) score, Oswestry Disability Index (ODI), modified MacNab criteria and postoperative complications.
RESULTS
The median follow-up time was 20.64 months (range, 19-21 months). The average operating time was 52.94±12.88 min (range, 35-78 min), including the working tube introduction time (13.59±2.89 min), decompression time (39.35±13.61 min), and the fluoroscopic time (3.65±2.52 min). Postoperative back VAS, leg VAS, and ODI were significantly improved compared with pre-operation, respectively (P<0.01). The overall excellent and good rate of these seventeen patients was 94%. There were no significant complications related to the operation.
CONCLUSIONS
Electromagnetic navigation system-assisted percutaneous full-endoscopic foraminoplasty and discectomy is a safe and effective method for treating LDH and this method has the advantage of short operative time and fluoroscopic times.
Topics: Diskectomy; Diskectomy, Percutaneous; Electromagnetic Phenomena; Humans; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 33183035
DOI: 10.21037/apm-20-1956 -
World Neurosurgery Jul 2021To compare and analyze efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar discectomy (OLD) for adolescent lumbar disc herniation. (Comparative Study)
Comparative Study
OBJECTIVE
To compare and analyze efficacy and safety of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar discectomy (OLD) for adolescent lumbar disc herniation.
METHODS
Clinical data of 257 patients with single-segment adolescent lumbar disc herniation who underwent surgical treatment from January 2015 to December 2019 were retrospectively collected. The patients were divided into PELD and OLD groups based on the surgical method used. Propensity score matching was performed using preoperative baseline data of patients in both groups, and some patients in both groups were selected for comparative study. Clinical and follow-up data were assessed and compared.
RESULTS
There was no statistically significant difference in preoperative baseline data between the 2 groups of patients after propensity score matching. Visual analog scale and Oswestry Disability Index scores improved in both groups postoperatively and at each follow-up time point (P < 0.05). However, visual analog scale scores on the first postoperative day and Oswestry Disability Index scores at 3 months postoperatively were lower in the PELD group than in the OLD group (P < 0.05). Duration of surgery, intraoperative blood loss, and duration of postoperative hospitalization were lower in the PELD group than in the OLD group (P < 0.05). There was no statistically significant difference between the 2 groups when comparing complication and recurrence rates (P >0.05).
CONCLUSIONS
Both PELD and OLD are effective and safe surgical techniques for treatment of adolescent lumbar disc herniation. However, compared with OLD, PELD is more advantageous for rapid symptom relief and improving postoperative quality of life with a low rate of complications and recurrence.
Topics: Adolescent; Diskectomy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Postoperative Complications; Retrospective Studies; Treatment Outcome
PubMed: 33989822
DOI: 10.1016/j.wneu.2021.05.007 -
Pain Physician Jul 2020Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc...
BACKGROUND
Posterolateral endoscopic lumbar discectomy (PLELD) or percutaneous endoscopic lumbar discectomy has been reported to be effective as treatment for herniated lumbar disc in degenerative spondylolisthesis. Few studies have investigated the outcomes of open lumbar microdiscectomy (OLM) and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
OBJECTIVES
We aimed to evaluate the outcomes of OLM and PLELD for antero- and retrospondylolisthesis with mild slippage and instability.
STUDY DESIGN
This study used a retrospective design.
SETTING
Research was conducted in a hospital and outpatient surgical center.
METHODS
This study enrolled 84 patients aged 20 to 60 years with low-grade degenerative spondylolisthesis who underwent OLM or PLELD for antero- or retrospondylolisthesis at our hospital between March 2007 and August 2014 and who were followed up for at least 3 years. Telephone survey and chart review, with a particular focus on pre- and postoperative radiographic parameters, were conducted. Additionally, patients were invited to undergo reexamination to update their clinical and radiological data.
RESULTS
Telephone surveys and clinical/imaging evaluation were conducted on the OLM and PLELD groups at a mean of 71.44 and 74.69 months, respectively. Out of 43 patients who underwent OLM, 34 responded to the telephone survey, 17 of whom then underwent reexamination. Among 41 patients who underwent PLELD, 32 responded to the telephone survey, 19 of whom then underwent reexamination. Based on telephone surveys and patient charts, reoperation at the same vertebral level was confirmed in 8 patients (23.5%) who underwent OLM and one patient (4.4%) who underwent PLELD, with a significantly higher rate of reoperation in the OLM group (P = .028). Vertebral disc height decreased more after OLM than after PLELD. Compared to PLELD, OLM was associated with significantly worse rates of iatrogenic endplate damage, endplate defect scores, and alterations in subchondral bone signal intensity. However, the final clinical outcomes did not differ between OLM and PLELD.
LIMITATIONS
The limitations of this study include its relatively small sample size and the possibility of bias owing to nonrandomized patient selection.
CONCLUSIONS
In patients with spondylolisthesis who have a herniated lumbar disc as mild slippage with instability, PLELD may be a good treatment option to reduce recurrence rates and mitigate disc degeneration. IRB approval number: 2016-12-WSH-011.
KEY WORDS
Anterospondylolisthesis, disc degeneration, endplate, herniated lumbar disc, open lumbar discectomy, percutaneous endoscopic lumbar discectomy, posterolateral endoscopic lumbar discectomy, retrospondylolisthesis, slippage.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Microsurgery; Middle Aged; Retrospective Studies; Spondylolisthesis; Treatment Outcome; Young Adult
PubMed: 32709174
DOI: No ID Found -
Journal of Orthopaedic Surgery and... Jul 2022To evaluate the efficacy and feasibility of percutaneous endoscopic interlaminar discectomy (PEID) via the inner border of the inferior pedicle approach for downmigrated... (Review)
Review
OBJECTIVE
To evaluate the efficacy and feasibility of percutaneous endoscopic interlaminar discectomy (PEID) via the inner border of the inferior pedicle approach for downmigrated disc herniation.
METHODS
Seventeen patients who had downmigrated disc herniation were included in this study from May 2020 to February 2021. After PEID via the inner border of the inferior pedicle approach, a retrospective study was conducted on all patients. Radiologic findings were investigated, and based on the level of migration seen on preoperative magnetic resonance imaging (MRI), participants were divided into two types (high-grade and low-grade migrations). Preoperative, 1st post-operative day, 3rd post-operative month, and the final follow-up visual analogue scale (VAS) assessments for back and leg pain and preoperative, 3rd post-operative month, and the final follow-up Oswestry disability index (ODI) evaluations were performed. The clinical effects at the final follow-up were assessed by the modified MacNab criterion.
RESULTS
All patients successfully completed surgery. There were 10 males and 7 females in the group. These patients were 42 years old on average (range, 25-68 years). Four and 13 patients had downmigrated disc herniation with high-grade and low-grade, respectively, on MRI. The mean follow-up duration was 10.47 ± 1.84 months (range, 8-14 months). The mean VAS score for back and leg improved from 5.18 ± 0.81 preoperatively to 1.35 ± 0.49 at the final follow-up (P < 0.05) and 6.94 ± 0.66 preoperatively to 1.47 ± 0.51 at the final follow-up (P < 0.05), respectively. The mean ODI score improved from 48.00 ± 3.64 preoperatively to 18.71 ± 1.31 at the final follow-up (P < 0.05). According to the modified MacNab criterion, 15 patients (88.2%) obtained excellent, while the rest 2 patients (11.8%) reported good outcomes.
CONCLUSION
PEID via the inner border of the inferior pedicle approach could be a good alternative option for the treatment of downmigrated disc herniation.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Retrospective Studies; Treatment Outcome
PubMed: 35864515
DOI: 10.1186/s13018-022-03245-8 -
The Journal of International Medical... Jan 2021Pediatric lumbar disc herniation (LDH), although uncommon, causes significant pain, discomfort, and sometimes disability. We examined the efficacy of percutaneous... (Review)
Review
Efficacy of percutaneous endoscopic lumbar discectomy for pediatric lumbar disc herniation and degeneration on magnetic resonance imaging: case series and literature review.
OBJECTIVE
Pediatric lumbar disc herniation (LDH), although uncommon, causes significant pain, discomfort, and sometimes disability. We examined the efficacy of percutaneous endoscopic lumbar discectomy (PELD) for pediatric LDH and the degree of lumbar disc degeneration at 1 year after PELD.
METHODS
We retrospectively reviewed the data of pediatric patients with LDH who underwent PELD from December 2007 to July 2018. The patients' symptoms, physical examination findings, clinical images, visual analog scale (VAS) scores, Oswestry Disability Index (ODI), and perioperative results (blood loss, length of hospital stay, and complications) were obtained from the medical records. Lumbar disc degeneration was graded using the modified Pfirrmann grading system at the 1-year postoperative magnetic resonance imaging (MRI) examination.
RESULTS
Six boys and four girls who underwent PELD were evaluated. The patients' mean age was 15.6 years (range, 13-17 years). The mean VAS score for low back pain, mean VAS score for lower limb pain, and mean ODI preoperatively and 1 year postoperatively were 6.2 and 0.3, 6.9 and 0.5, and 20 and 0.1, respectively. MRI showed significant disc degeneration after PELD.
CONCLUSIONS
Treating pediatric LDH with PELD is safe and effective. It relieves pain and reduces disability. However, lumbar disc degeneration still occurs.
Topics: Adolescent; Child; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Retrospective Studies; Treatment Outcome
PubMed: 33472475
DOI: 10.1177/0300060520986685 -
Cirugia Y Cirujanos 2023The aim of the study was to explore the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment...
BACKGROUND
The aim of the study was to explore the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH).
MATERIAL AND METHODS
The complete clinical data from 87 patients with LDH from our hospital were retrospectively analyzed. Patients were divided into a control group (n = 39, treated with FD) and a research group (n = 48, treated with PTED) according to the prescribed treatments. The basic operation conditions were compared across the two groups. Surgical outcomes were assessed. The incidences of complications and the life quality of patients were evaluated 1 year after surgery.
RESULTS
The patients in both groups completed the operation. The visual analog scale and Oswestry Disability Index score of patients in the research group was significantly lower while the Orthopaedic Association Score was significantly higher after surgery. The success rate of the operation in the research group which was significantly higher and the rate of complications was significantly lower. No statistical differences in the quality of life were observed between the patients (p > 0.05).
CONCLUSIONS
PTED and FD are effective in the treatment of LDH. However, our study showed that PTED has a higher rate of treatment success, faster recovery times and is safer than FD.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Quality of Life; Lumbar Vertebrae; Endoscopy; Diskectomy; Treatment Outcome
PubMed: 37084301
DOI: 10.24875/CIRU.21000774 -
Neurology India 2022Minimally invasive spine surgery (MISS) is a set of techniques and procedures that reduces the local tissue injury while achieving the same results through traditional...
BACKGROUND AND INTRODUCTION
Minimally invasive spine surgery (MISS) is a set of techniques and procedures that reduces the local tissue injury while achieving the same results through traditional open surgery. The techniques for the treatment of lumbar disc herniation and degenerative canal stenosis have evolved from tubular discectomy to endoscopic discectomy. This helps in preserving spine function. Good clinical outcomes have been reported with the use of an endoscope for degenerative lumbar disc disease.
OBJECTIVE
In this video abstract, we present a case lumbar foraminal stenosis in an elderly man that was treated successfully using unilateral biportal endoscopic spine surgery. (UBESS).
SURGICAL TECHNIQUE
A 70-year-old man presented with progressive neurogenic claudication and left L4 numbness and paresthesias. His claudication distance was 200 m. His MRI Lumbosacral spine showed severe left L4-5 foraminal stenosis due to a disc prolapse. The patient underwent a left-sided unilateral biportal endoscopic transforaminal decompression and discectomy at L4-5 successfully. Postoperative period was uneventful and the patient had significant relief in his symptoms. Postoperative MRI Lumbosacral spine showed no muscle damage with adequate decompression at left L4-5 level.
RESULTS
The patient had an uneventful recovery.
CONCLUSION
Biportal percutaneous transforaminal endoscopic discectomy/decompression is an ideal alternative to the uniportal endoscopic and minimal invasive microsurgery for foraminal and paracentral disc herniations and lateral recess and foraminal stenosis.
Topics: Aged; Constriction, Pathologic; Decompression, Surgical; Diskectomy; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Treatment Outcome
PubMed: 35532611
DOI: 10.4103/0028-3886.344669 -
Pain Physician Nov 2022Postoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and... (Observational Study)
Observational Study
BACKGROUND
Postoperative upper-limb palsy (ULP) is a serious complication after cervical spine surgery. ULP after posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPCED) has not yet been reported.
OBJECTIVE
To introduce cases of postoperative ULP after PPCED and associated risk factors.
STUDY DESIGN
A single-center, retrospective, observational study.
SETTING
Shanghai Changzheng Hospital, Naval Medical University, Shanghai, China.
METHODS
From January 2016 through January 2022, PPCED involving a total of 663 segments was performed in 610 patients with radiculopathy who were diagnosed with cervical radiculopathy or mixed cervical spondylosis caused by foraminal stenosis or posterolateral disc herniation.
RESULTS
PPCED was successfully completed in 610 patients, 6 of whom (0.98%) developed ULP. Two patients were diagnosed with double-segment cervical nerve root canal stenosis (C4/5/6, C5/6/7) and 2 with migrated cervical disc soft herniation (a magnetic resonance image of one showed a migrated disc herniation downward from C4/5 in the sagittal plane; another showed this upward from C5/6); one patient was diagnosed with C5/6 intervertebral foraminal stenosis, and one had simple C4/5 lateral disc herniation. Postoperative ULP rates for C4/5 (2/30, 6.67%) and C5/6 (2/177, 1.13%) were much higher than those for the other levels. Anatomically, the width of the intervertebral foramen on computed tomography was 2.3 ± 1.12 mm in ULP cases, which was significantly lower than that in non-ULP cases (3.4 ± 1.83, P < 0.05). This suggests that preoperative foramen width correlates highly negatively with postoperative ULP incidence.
LIMITATIONS
This was a single-center, retrospective, nonrandomized study with a low level of evidence.
CONCLUSIONS
PPCED is a good treatment for cervical radiculopathy. The rate of postoperative ULP after PPCED is much lower than that after posterior cervical foraminotomy. Perturbation to the C5 (or C6) nerve root, thermal injury due to burr use or the radiofrequency applied, and marked foraminal stenosis are possible relevant factors associated with postoperative ULP.
Topics: Humans; Foraminotomy; Intervertebral Disc Displacement; Radiculopathy; Constriction, Pathologic; Retrospective Studies; Cervical Vertebrae; China; Diskectomy; Paralysis; Upper Extremity; Treatment Outcome
PubMed: 36375202
DOI: No ID Found