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BMC Musculoskeletal Disorders Mar 2022Multiple surgical approaches have been studied and accepted for the removal of highly downward migrated lumbar disc herniation (LDH). Here, we investigated the efficacy...
BACKGROUND AND STUDY AIMS
Multiple surgical approaches have been studied and accepted for the removal of highly downward migrated lumbar disc herniation (LDH). Here, we investigated the efficacy and safety of full-endoscopic foraminoplasty for highly downward migrated LDH.
PATIENTS AND METHODS
Thirty-seven patients with highly down-migrated LDH treated by the full-endoscopic foraminoplasty between January 2018 and January 2020 were retrospectively investigated. Clinical parameters were evaluated preoperatively and 1, 6, and 12 months postoperatively, using pre- and post-operative Oswestry Disability Index (ODI) scores for functional improvement, visual analog scale (VAS) for leg and back pain, and modified MacNab criteria for patients satisfactory.
RESULTS
Thirty-seven patients with highly downward migrated LDH were successfully removed via the transforaminal full-endoscopic discectomy. The average VAS back and leg pain scores were significantly reduced from 7.41 ± 1.17 and 8.68 ± 1.06 before operation to 3.14 ± 0.89 and 2.70 ± 0.46 at postoperative 1 month, and 1.76 ± 0.59 and 0.92 ± 0.28 at postoperative 12 months, respectively (P < 0.05). The average ODI scores were reduced from 92.86 ± 6.41 to 15.30 ± 4.43 at postoperative 1 month, and 9.81 ± 3.24 at postoperative 12 months (P < 0.05). Based on the modifed MacNab criteria, 36 out of 37 patients (97.30%) were rated as excellent or good outcomes.
CONCLUSION
The full-endoscopic foraminoplasty can be used successfully for surgical removal of high grade down-migrated LDH, and it could serve as an efficient alternative technique for patients with highly downward migrated LDH.
Topics: Back Pain; Diskectomy, Percutaneous; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 35351069
DOI: 10.1186/s12891-022-05254-4 -
Pain Physician Jul 2017Herniated intervertebral disc disease (HIVD) is a common cause of lower back and leg pain. Percutaneous endoscopic lumbar discectomy (PELD) is indicated when...
BACKGROUND
Herniated intervertebral disc disease (HIVD) is a common cause of lower back and leg pain. Percutaneous endoscopic lumbar discectomy (PELD) is indicated when non-surgical treatments such as medication and interventions are intractable. Ruptured discs and loose fragments inside discs are removed during PELD. Nerve root decompression is usually assessed by visualizing the free movement of the traversing nerve root or epidural fat, the free passage of a probe into the epidural space, the depression of the annulus, and the removal of the expected ruptured discs and loose fragments based on preoperative magnetic resonance images (MRI). However, these criteria are subjective, and the quantity of the disc removal necessary for successful outcomes after PELD has not been investigated.
OBJECTIVES
The present study investigates the amount of discectomy of PELD and its clinical and radiological outcomes.
STUDY DESIGN
A retrospective case study (IRB Number H-1611-015-803).
SETTING
University Medical Center, Seoul, Korea.
METHODS
PELD was performed in 109 consecutive patients (M:F = 53:56; mean age, 37.4 years) using the transforaminal or interlaminar route. Ruptured disc fragments were first removed in all patients, and the graspable loose fragments under the disc were removed. After surgery, all removed disc fragments were placed into disposable syringes and manually compressed to measure their volume. The volume of herniated disc outside the disc boundary was calculated in MRI. The measured and calculated disc volumes were retrospectively compared. Clinical success was defined as an improvement in both the Oswestry Disability Index (ODI) and leg pain, as well as no recurrent symptoms. Radiological success was defined as the disappearance of herniated disc material outside the disc boundary based on postoperative MRI taken within one day after surgery. The follow-up period was 7.2 ± 5.2 months.
RESULTS
Successful clinical outcomes were obtained in 96/109 (88.1%) patients in a median time of 3 months. Re-operation was performed in 3 patients due to recurrent discs in 2 patients and a residual disc in one patient. Predictors of clinical success were not identified, and the quantity of the removed disc was not associated with the clinical outcome. Radiological success was achieved in 93/109 (85.3%) patients. Of 13 patients with radiological failure, 2 patients showed clinical failure. A logistic regression analysis showed that the relative volume of the removed disc (%) compared with the volume of preoperative herniated disc based on the MRI was the only significant predictor (P < 0.001; OR = 0.96). When 100% of the calculated disc amount was removed during the operation, the probability of residual disc was 30%. When 131% of the calculated disc amount was removed, the probability of residual disc was 10%.
LIMITATIONS
This study employed a retrospective design, and its inherent selection bias and limited statistical power should be considered.
CONCLUSIONS
The amount of disc removal during PELD was not a significant predictor of clinical success after the primary ruptured fragments were removed. The relative volume of the removed disc based on the preoperative MRI might predict the postoperative MRI.
KEY WORDS
Disc, lumbar vertebra, discectomy, surgery, endoscopy, volume.
Topics: Adolescent; Adult; Aged; Arthroscopy; Diskectomy, Percutaneous; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Outcome and Process Assessment, Health Care; Retrospective Studies; Young Adult
PubMed: 28727718
DOI: No ID Found -
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 -
Neurospine Mar 2023The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and...
The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and fusion rate. However, significant perioperative morbidity related to extensive surgical exposure has been reported. Therefore, anterior endoscopic cervical discectomy (AECD) using a working channel endoscope has been developed to reduce surgical complications and tissue damage. The objective of this study was to describe a cutting-edge technique for AECD of soft CDH. The primary indication is cervical radiculopathy with or without axial neck pain due to soft CDH. The surgical procedure consists of 2 parts: (1) a safe anterior percutaneous approach under fluoroscopic control and (2) selective endoscopic discectomy and foraminal decompression using specialized mechanical tools under endoscopic visualization. The clinical outcomes are comparable to those of conventional surgery and show the benefits of minimally invasive spine procedure. Perioperative data revealed typical minimalism, including reduced muscle damage, blood loss, operative time, and recovery time. With technical advancements in surgical instruments and optics, AECD will become more practical and safer. AECD is effective in selected CDH cases with cervical radiculopathy. However, high-quality clinical studies are needed to verify the effectiveness of this endoscopic cervical spinal procedure.
PubMed: 37016849
DOI: 10.14245/ns.2346118.059 -
Orthopaedic Surgery Feb 2022This retrospective case-control study aimed to evaluate and compare the clinical outcomes of full-endoscopic visualized foraminoplasty and discectomy (FEVFD) with...
OBJECTIVE
This retrospective case-control study aimed to evaluate and compare the clinical outcomes of full-endoscopic visualized foraminoplasty and discectomy (FEVFD) with microdiscectomy (MD) for lumbar disc herniation (LDH).
METHODS
Data from 198 patients who presented with LDH between January 2016 and December 2017 treated by either FEVFD or MD were retrospectively analyzed. The inclusion criteria were single-level LDH, unilateral radiating leg pain with or without positive Lasegue's sign, and failure of standard conservative treatment for at least 12 weeks. The patients were categorized into an FEVFD group (n = 102) or an MD group (n = 96), according to the surgical procedure performed. Operative time, time in bed after surgery, postoperative hospitalization time, complications, and reoperations were recorded. Visual analog scales (VAS) for leg and back pain, Oswestry Disability index (ODI), 36-Item Short-Form Health Survey physical function (SF36-PF), and bodily pain (SF36-BP) scores were assessed and compared between the two groups.
RESULTS
The demographic data and baseline characteristics of the two groups were not significantly different. Operative time for the FEVFD group (73.82 ± 20.73 min) was longer than that for the MD group (64.74 ± 17.37 min) (P = 0.003), and fluoroscopy time for the FEVFD group (1.71 ± 0.58s) was longer than that for the MD group (1.30 ± 0.33s) (P < 0.001). However, time in bed experienced in the FEVFD group (8.51 ± 2.10 h) was less than that in the MD group (9.24 ± 2.01 h) (P = 0.014), and postoperative hospitalization time experienced in the FEVFD group (2.89 ± 0.83d) was also shorter than that in the MD group (4.94 ± 1.35d) (P < 0.001). All patients completed 24 months of follow-up. Postoperative scores at each follow-up for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP all improved significantly for both groups, as compared to the preoperative data (P < 0.05). The mean preoperative and postoperative scores for the VAS for leg and back pain, ODI, SF36-PF, and SF36-BP were not significantly different between the two groups. According to the modified MacNab criteria, the outcomes of the procedures were rated as excellent or good by 92.16% and 93.75% of the patients in the FEVFD and MD groups, respectively. One patient suffered a nerve root injury during the discectomy, one patient suffered from a dural tear, and two patients suffered from a residual herniation in the FEVFD group. One patient in the MD group suffered from poor wound healing. Moreover, recurrence happened in two cases in the FEVFD group, and in one case in the MD group.
CONCLUSION
FEVFD and MD are both reliable techniques for the treatment of symptomatic LDH. FEVFD resulted in a more rapid recovery and equivalent clinical outcomes after 24 months of follow-up.
Topics: Case-Control Studies; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 34914186
DOI: 10.1111/os.13087 -
Photomedicine and Laser Surgery Dec 2014Results following anterior cervical discectomy (ACD) without fusion are not well reported because of skepticism that the disturbed cervical spine anatomy after ACD might...
OBJECTIVE
Results following anterior cervical discectomy (ACD) without fusion are not well reported because of skepticism that the disturbed cervical spine anatomy after ACD might compromise clinical outcome. The purpose of this study was to determine whether ACD without fusion prompts the degenerative process significantly, and whether it is necessary to preserve disc height and cervical alignment for the sake of better clinical outcome following cervical spine surgery.
BACKGROUND DATA
Out of 56 consecutive patients, 37 patients who replied and consequently underwent postoperative MRI from April to June 2009 were included in this study.
MATERIAL AND METHODS
A total of 37 consecutive patients diagnosed as having cervical monoradiculopathy and treated with percutaneous endoscopic cervical discectomy (PECD) were investigated. Angle of cervical lordosis, change in cervical range of motion, disc height change, and degree of degenerative changes at the corresponding level were evaluated. The visual analogue scale (VAS) score for neck and arm pain and the neck disability index (NDI) were compared preoperatively and at the final follow-up. The mean follow-up period was 45.5 months.
RESULTS
Despite prompted radiological deterioration such as loss of disc height (the posterior disc heights and central disc height ratio were significantly decreased from 3.6 to 2.6 mm, from 30.3% to 24.5%, respectively, p<0.05) or degenerative progression (from average grade of 2.8 to 4.1, p<0.05), the patients achieved significant improvement in clinical outcomes (VAS for neck and arm dropped from mean 6.3 and 7.5 to 2.7 and 2.6, respectively, and NDI score improved from 46.8% to 17.2%, p<0.05) after PECD.
CONCLUSIONS
Neither loss of disc height nor progression of degeneration at disc space compromised clinical outcome after PECD without fusion on long-term follow-up.
Topics: Cervical Vertebrae; Diskectomy, Percutaneous; Endoscopy; Female; Fluoroscopy; Follow-Up Studies; Humans; Image Interpretation, Computer-Assisted; Intervertebral Disc Displacement; Magnetic Resonance Imaging; Male; Pain Measurement; Radiculopathy; Treatment Outcome
PubMed: 25393058
DOI: 10.1089/pho.2014.3806 -
The Western Journal of Medicine Mar 1995
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc Displacement
PubMed: 7725712
DOI: No ID Found -
Orthopaedic Surgery May 2022To compare the efficacy and safety of retaining the posterior longitudinal ligament (PLL) with resecting the PLL in inside-out percutaneous endoscopic transforaminal...
A Comparison Between Retaining and Resecting the Posterior Longitudinal Ligament in Percutaneous Endoscopic Transforaminal Discectomy for Disc Herniation: A Retrospective Cohort Study.
OBJECTIVE
To compare the efficacy and safety of retaining the posterior longitudinal ligament (PLL) with resecting the PLL in inside-out percutaneous endoscopic transforaminal discectomy (PETD) surgery for lumbar disc herniation (LDH).
METHOD
A total of 135 patients with symptomatic LDH who were treated by inside-out PETD surgery from January 2015 to January 2017were included in this retrospective analysis. There were 38 males and 30 females in the PLL resection group (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the PLL retention group (mean age = 53.50 ± 9.24 years). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH, and complications were recorded. Three months after surgery, magnetic resonance imaging was performed to confirm that nerve root compression was relieved.
RESULTS
The VAS and ODI scores improved significantly immediately after surgery, at 1 month after surgery, at 3 months after surgery, and at last follow-up compared with those before surgery (P < 0.01). The scores also improved significantly between immediately after surgery and 1 month after surgery in the two groups (P < 0.001). Multivariate analysis indicated that age ≥ 50 years (odds ratio (OR) = 6.33, 95% confidence interval (CI): 1.64-21.98, P = 0.014), pain duration ≥6 months (OR = 4.68, 95% CI: 1.29-6.51, P = 0.025), pre-ODI score ≥ 40% (OR = 5.97, 95% CI: 2.41-14.86, P = 0.003) were all associated with poor functional outcomes. There was no significant difference in the excellent/good ratio between the two groups and the mean operation time of the retention group was 71.5% of that of the resection group (82.7 ± 18.5 min vs 115.6 ± 24.6 min, P < 0.01). In the patients, no serious complications, such as dural tear, wound infection, or persistent nerve root injury, were observed during the follow-up period. There was no significant difference in the complication rate between the two groups (6/68 vs 6/67, P = 0.979). Although the recurrence rate was higher in retention group, there was no significant difference between the two groups (1/68 vs 2/67, P = 0.551).
CONCLUSION
The PLL is recommended to be retained for inside-out PETD surgery.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Longitudinal Ligaments; Lumbar Vertebrae; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 35445546
DOI: 10.1111/os.13257 -
Orthopaedic Surgery Jan 2022To investigate the feasibility and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) with three-step maneuver for puncture (TSMP) for lumbar herniated...
OBJECTIVE
To investigate the feasibility and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) with three-step maneuver for puncture (TSMP) for lumbar herniated disc (LDH).
METHODS
We performed a retrospective review of 30 patients who underwent PTED using TSMP for LDH and met inclusion criteria from January 2018 to September 2018. The primary outcome, leg or back pain, was assessed using Visual Analogue Scale (VAS). Patient surgical satisfaction was measured at 12 months post surgery using a five-point Likert scale. Potential prognostic factors measured were demographic characteristics, duration of symptom (DOS), and involved levels. Statistical analysis was performed using Fisher exact test and t-test. TSMP is a three-step maneuver that builds on the concept of needle puncture site and trajectory determination based on the principles of Kambin's triangle. First, accurate direction of the puncture is confirmed by inserting the needle horizontally. Then by gradually raising the needle tail in the manner described, the superior articular facet and the intervertebral foramen are sequentially located. Finally, the needle tip slides into the intervertebral foramen to reach the target superior articular facet.
RESULTS
Preoperative mean VAS was 7.6 ± 1.19, which decreased to 1.4 ± 0.97 at 12 months following treatment (P < 0.0001). Rates of surgical satisfaction per Likert scale were as follows: very satisfied and satisfied in 26 patients (86.7%). Three recurrent disc herniations of adjacent segmental levels were observed in the L5-S1 group at eight and 12 months after surgery. VAS scores at 12 months varied significantly between L4-L5 level surgery and L5-S1 level surgery groups (P < 0.01).
CONCLUSION
TSMP is a reliable technique for puncture into the intervertebral foramen.
Topics: Adult; Diskectomy, Percutaneous; Endoscopy; Feasibility Studies; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Punctures; Retrospective Studies; Treatment Outcome
PubMed: 34873865
DOI: 10.1111/os.13113 -
BioMed Research International 2019To predict the early recurrence after full endoscopic lumbar discectomy, we analyzed factors related to demographic factor anatomical factors, operative method, and...
PURPOSE
To predict the early recurrence after full endoscopic lumbar discectomy, we analyzed factors related to demographic factor anatomical factors, operative method, and postoperative management, and predicted the possibility of recurrence according to the scoring system.
MATERIALS AND METHODS
In this prospective study, we enrolled 300 patients who underwent 1 out of 3 surgical procedures. The patients were randomized into one of the following groups: group A ( = 100), transforaminal inside-out approach; group B ( = 100), transforaminal outside-in approach; and group C ( = 100), interlaminar approach. The clinical results were evaluated by a visual analogue scale (VAS). Related factors evaluated with points of (A) demographic factors: (1) age, (2) gender, (3) BMI, (B) anatomical factors: (4) disc degeneration scale, (5) modic change, (6) number of involved disc herniation, (7) history of discectomy (first, recurred), (8) herniated disc level, (9) disc height, (10) segmental dynamic motion, (11) disc location, (C) operation factors: (12) annulus preservation along the disc protrusion, (13) approach method (transforaminal inside-out, transforaminal outside-in, interlaminar); (D) postoperative care factors: (14) early ambulation, (15) spinal orthosis (corset) application. Among these, we analyzed statistically significant recurrence risk factors after PELD in all patients and early recurrence predicting score ratio was obtained.
RESULTS
The overall recurrence rate was 9.33%. The recurrence rate was 11%, 10%, and 7% for groups A, B, and C, respectively. Average early recurrence time was 3.26 months. The change in preoperative and postoperative VAS score was from 8.07 to 1.39, 8.34 to 1.34, and 8.14 to 1.86 in groups A, B, and C, respectively. The recurrence rate based on the (1) age was <40 years: 5.22% (6/115), 41-60 years: 16.1% (20/124), and >61 years: 3.07% (2/65); (2) gender was male: 13/139 (9.35%), female: 15/161 (9.32%); (3) BMI was obese: 17.57% (13/74), overweight: 11.6% (9/77), underweight: 6.35% (4/63), and normal weight: 2.33% (2/86); (4) degeneration scale was grades 1-2: 2% (1/50), grade 3: 7.4% (10/135), and grades 4-5: 14.8% (17/115); (5) modic change was type I: 25% (3/12), type II: 14.3% (1/7), type III: 33% (1/3), and no modic change: 8.27% (23/278); (6) number of involved disc herniation was 1 level: 3.9% (5/128), 2 level: 10.4% (13/125), 3 levels: 18.9% (7/37), and 4 levels: 30% (3/10); (7) history of discectomy was first: 8.83% (25/283) and repeated: 17.65% (3/17); (8) herniated disc level was L1-L2/L2-L3/L3-L4: 3.95% (3/76) and L4-L5: 14.6% (18/123); (9) disc height was <80%: 17.14% (6/35), 81%-100%: 8.16% (12/147), and >101%: 8.5% (10/118); (10) segmental dynamic motion was 1-10°: 8.58% (20/233) and 11-20° : 11.9% (8/67); (11) disc location was central: 7.41% (2/27), foraminal: 3.03% (2/66), and inferior/superior/paracentral: 11.59% (24/207); (12) radical annulotomy was 8.05% (7/87) vs. 9.86% (21/213); (13) approach method was transforaminal (inside-out): 11% (11/100), transforaminal (outside-in): 10% (10/100), and interlaminar: 7% (7/100); (14) early ambulation was 16.42% (23/140) vs. 3.13% (5/160); and (15) spinal orthosis application was 7.35% (10/136) vs. 10.98% (18/164). According to the above results, after summation of all scores, the early recurrence predicting score: recurrence rate ratio was 1-4: 0% (0/23), 5-8: 7.1% (13/183), 9-12: 8% (6/75) and 13-16 100% (10/10).
CONCLUSIONS
Early recurrence after PELD is associated with several risk factors such as BMI, degeneration scale, combined HNP, and early ambulation. If we use the predicting score, we can postulate the occurrence of early recurrence after PELD. Knowing the predictive factors prior to surgical intervention will allow us to decrease the early recurrence rate after PELD.
Topics: Adult; Aged; Aged, 80 and over; Diskectomy, Percutaneous; Endoscopy; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Recurrence; Risk Factors
PubMed: 31828113
DOI: 10.1155/2019/6492675