-
Orthopaedic Surgery May 2023Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management... (Review)
Review
OBJECTIVE
Postoperative discal pseudocyst (PDP) is a rare complication after discectomy. This study aimed to summarize the characteristics, pathological mechanisms and management of PDPs.
METHODS
Nine patients with PDP who received surgical treatment at our institution from January 2014 to December 2021 were retrospectively reviewed. A systematic review of the literature on PDP was performed. The demographic data, clinical and imaging features, surgical options and patient prognosis were analyzed.
RESULTS
Among the nine patients treated at our center, seven were male and two were female. The mean patient age (± standard deviation) at the time of surgery was 28.3 ± 5.7 years (range 18-37 years). The first operation performed on seven patients was percutaneous endoscopic transforaminal discectomy (PETD) and two patients underwent microdiscectomy. The time to conservative treatment before surgical intervention was 20 ± 9.2 days. In three cases, the disc cysts were located in L4/5 and in six cases the lesions were located in L5/S1. Intervertebral disc cyst interventions included foraminal scope (three cases), open discectomy (three cases), conservative treatment with a quadrant channel (one case) and CT-guided puncture (one case). All patients fully recovered after surgery and the mean follow-up time was 3.5 ± 2.1 years. A literature review identified 14 relevant articles that reported 43 PDP cases of PDP.
CONCLUSION
PDP occurs in Asian males with mild intervertebral disc degeneration and occurs 1 month after discectomy. Treatment should be based on specific patient scenarios. Conservative treatment is necessary and surgery should be performed with caution.
Topics: Humans; Male; Female; Adolescent; Young Adult; Adult; Intervertebral Disc Displacement; Retrospective Studies; Spinal Puncture; Lumbar Vertebrae; Diskectomy, Percutaneous; Endoscopy; Cysts; Treatment Outcome
PubMed: 36999347
DOI: 10.1111/os.13689 -
Pain Physician Jul 2021Although many studies have compared full endoscopic spine surgery and open spine surgery, few have compared the outcomes of percutaneous endoscopic interlaminar lumbar... (Observational Study)
Observational Study
BACKGROUND
Although many studies have compared full endoscopic spine surgery and open spine surgery, few have compared the outcomes of percutaneous endoscopic interlaminar lumbar discectomy (PEILD) and open lumbar microdiscectomy (OLM) at the L5-S1 level.
OBJECTIVES
We compared the clinical, surgical, and radiological outcomes of patients with disc herniation at the L5-S1 level who underwent either PEILD, or OLM, performed by a single surgeon with novice-level proficiency.
STUDY DESIGN
Observational, retrospective matched cohort design.
SETTING
An analysis of clinical data was performed at a single center, collected from September 2012 to August 2016.
METHODS
The study enrolled 56 patients who underwent discectomy at the L5-S1 level, with a minimum one-year follow-up. Patients were allocated to 2 groups: a PEILD group (n = 27; September 2014 to August 2016), or an OLM group (n = 29; September 2012 to August 2014). Clinical, surgical, and radiological outcomes were retrospectively evaluated.
RESULTS
Baseline characteristics including age, gender, past medical history, body mass index, preoperative symptom, and preoperative radiological findings did not differ significantly between the groups. Further, overall clinical outcomes including back and leg pain; surgical outcomes including blood loss, complication rate, and recurrence rate; and radiological outcomes including degree of decompression, disc height, and sagittal alignment were not different significantly between the 2 groups.However, the PEILD group showed significant advantages including lower immediate postoperative back pain (mean 1.44 [95% confidence interval (CI), 1.16-1.72] versus 2.41 [95% CI, 2.14-2.69], P < 0.001), favorable immediate postoperative Odom's criteria (excellent 57.14% versus 24.14%, P = 0.025), shorter operation time (mean 63.89 ±17.99 minutes versus 109.66 ±31.42 minutes, P < 0.001), shorter hospital stay (3.15 [95% CI, 2.21-4.09] days versus 5.72 [95% CI, 3.29-8.16] days, P < 0.001), and rapid return to work (15.67 [95% CI, 12.64-18.69] days versus 24.31 [95% CI ,19.97-28.65] days, P = 0.001).
LIMITATION
Due to its retrospective nature, it was not possible to control for all variations. Moreover, the number of patients in the final cohort was relatively small.
CONCLUSIONS
Our findings indicate that the PEILD group achieved better perioperative outcomes despite no significant intergroup difference in mid-term clinical and radiological outcomes.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Retrospective Studies; Treatment Outcome
PubMed: 34213872
DOI: No ID Found -
Pain Research & Management 2019Both transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty (TF PELF) and transforaminal percutaneous endoscopic lumbar discectomy without...
BACKGROUND
Both transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty (TF PELF) and transforaminal percutaneous endoscopic lumbar discectomy without foraminoplasty (TF PELD) were developed for lumbar disc herniation (LDH) patients. However, the safety and effectiveness between the TF PELF and TF PELD have not been investigated.
METHODS
Of the included 140 LDH patients, 62 patients received TF PELF (PELF group) and 78 patients received TF PELD (PELD group). The operation time, the duration of staying at the hospital, and complication incidences were recorded. All patients were followed up for 2 years, where low back and leg visual analogue scale (VAS) pain ratings and Oswestry Disability Index (ODI) were compared between the 2 groups before and after surgery. Modified Macnab criterion was estimated for all patients at postoperative 2 years.
RESULTS
There were no significant difference of the operation time, number of days staying at the hospital, and the incidence of complications between the 2 groups ( > 0.05). Two cases in the PELF group and 1 case in the PELD group received a second surgery due to unrelieved symptoms postoperatively. Low back and leg VAS and ODI scores decreased in both groups after operation ( < 0.01), respectively, but were not significant between the 2 groups over time ( > 0.05). Six patients in the PELF group and 3 patients in the PELD group did not continue the follow-up; thus, only 131 patients completed Macnab evaluation. The satisfactory rate was reported as 80.4% in the PELF group and 90.7% in the PELD group ( > 0.05).
CONCLUSIONS
This study suggested that the safety and effectiveness of TF PELF are comparable to TF PELD for LDH patients.
Topics: Adult; Diskectomy, Percutaneous; Female; Follow-Up Studies; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Retrospective Studies; Treatment Outcome
PubMed: 30719201
DOI: 10.1155/2019/6924941 -
Scientific Reports May 2022It is still an unsolved problem to achieve both immediate intraoperative feedback and satisfactory surgical experience in percutaneous endoscopic lumbar discectomy under...
It is still an unsolved problem to achieve both immediate intraoperative feedback and satisfactory surgical experience in percutaneous endoscopic lumbar discectomy under local anesthesia for lumbar disk herniation (LDH) patients. Herein, we compared the analgesic and sedative effects of local anesthesia alone and local anesthesia with conscious sedation in LDH patients during percutaneous endoscopic lumbar discectomy. Ninety-two LDH patients were enrolled and divided into the following groups: control group (Con Group), dexmedetomidine group (Dex Group), oxycodone group (Oxy Group), and dexmedetomidine + oxycodone group (Dex + Oxy Group). Various signs, including mean arterial pressure (MAP), heart rate (HR), pulse oximeter oxygen saturation (SpO) and Ramsay score, were compared before anesthesia (T1), working cannula establishment (T2), nucleus pulposus removal (T3), and immediately postoperation (T4). Clinical outcomes, including VAS score, operation time, hospitalization period, Macnab criteria, and SF-36 score, were also evaluated. The Dex + Oxy Group showed the most stable MAP and HR at T2 and T3 in all groups. The clinical outcomes, such as VAS, hospitalization period, Macnab criteria, and SF-36 score, have no significant differences among groups (p > 0.05). Local anesthesia combined with conscious sedation is a safe and effective method to improve the surgical experience and achieve satisfying clinical outcomes for LDH patients during percutaneous endoscopic lumbar discectomy.
Topics: Anesthesia, Local; Dexmedetomidine; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Oxycodone; Retrospective Studies; Treatment Outcome
PubMed: 35523922
DOI: 10.1038/s41598-022-11393-4 -
Pain Physician May 2017Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using...
BACKGROUND
Percutaneous full-endoscopic discectomy (PED) is being increasingly used because of its potential to minimalize soft-tissue damage and decrease hospital stay. PED using the interlaminar approach (PED-IL) at L4-L5 is performed by only a few surgeons. To the best of our knowledge, the safety and efficacy of PED-IL at L4-L5, without experience in PED via a transforaminal approach (PED-TF) has not been previously reported.
OBJECTIVE
This study aimed to evaluate initial clinical outcomes and complications of PED-IL at L4-L5 without experience in PED-TF.
STUDY DESIGN
Retrospective evaluation.
SETTING
An urban minimally invasive spine hospital.
METHODS
Of a total of 50 patients (36 men and 14 women, ages ranging from 21-59 years, with the average age being 40.3 years old), 16 cases were performed at L4-L5 and 34 cases were performed at L5-S1. PED-IL was successfully completed in all cases, and no case required conversion to open surgery. The operative time, hospital stay, modified MacNab criteria, and visual analog scale (VAS) scores were examined at L5-S1 (range: 41-112). There was no significant difference in operative time between the L4-L5 and L5-S1 groups; the operative time was gradually decreased. The mean hospital stay was 2.9 days (range: 2-8 days). According to modified MacNab criteria, 20 cases (6 at L4-L5 and 14 at L5-S1) were excellent, 27 (10 at L4-L5 and 17 at L5-S1) were good, one at L5-S1 was fair, and 2 at L5-S1 were poor. Two perineurium tears occurred at L5-S1. There was no infection or recurrence of herniated nucleus pulposus (HNP). The clinical outcomes of PED-IL at L4-L5 were equal to those at L5- S1.
RESULTS
The mean operative time was 71.3 ± 19.3 minutes for all cases (range: 41-112 mins.),76.1 ± 16.8 minutes at L4-L5 (range: 52-102 mins.), and 70.5 ± 20.1 minutes at L5-S1 (range: 41-112 mins.).
LIMITATIONS
A small sample size and a short follow-up period.
CONCLUSIONS
The clinical outcomes of PED-IL at L4-L5 were equal to those at L5-S1. Therefore, PED-IL is suitable to be a standard method for any type of intracanalicular disc herniation.
Topics: Adult; Diskectomy, Percutaneous; Female; Humans; Intervertebral Disc Displacement; Length of Stay; Lumbar Vertebrae; Male; Middle Aged; Operative Time; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 28535559
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 -
Medicine Oct 2020Despite some researchers have compared the safety and effectiveness of percutaneous endoscopic discectomy (PED) and microendoscopic discectomy (MD) for the lumbar disc... (Comparative Study)
Comparative Study
BACKGROUND
Despite some researchers have compared the safety and effectiveness of percutaneous endoscopic discectomy (PED) and microendoscopic discectomy (MD) for the lumbar disc herniation; however, they got conflicting outcomes in several variables. Therefore, our aim was to clarify whether PED produces less surgical trauma and better clinical results than MD.
METHODS
A single-center, retrospective cohort trial was conducted for the comparison of the safety and effectiveness between the MD and PED in the patients with lumbar disc herniation who received surgery from May 2016 to July 2018 in our hospital. The inclusion criteria for our investigation included:The follow-ups were performed 6 weeks, 3, 6, 12 and 24 months after the surgery. Numeric Rating Scale, Short-form 36, and Oswestry Disability Index, as well as complications were evaluated in our study. The software of SPSS Version 22.0 (IBM Corporation, Armonk, NY) was applied to analyze all the statistical data. When P is less than .05, the difference is significant in statistics.
RESULTS
This protocol will provide a solid theoretical basis for exploring which technique is better in treatment of lumbar disc herniation.
TRIAL REGISTRATION
This protocol was registered in Research Registry (researchregistry6005).
Topics: Cohort Studies; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae
PubMed: 33080722
DOI: 10.1097/MD.0000000000022709 -
Turkish Neurosurgery 2021To investigate and compare the therapeutic efficiency and radiographic measurement between the transforaminal approach and interlaminar approach in percutaneous...
Comparative Analysis of the Therapeutic Efficiency and Radiographic Measurement Between the Transforaminal Approach and Interlaminar Approach in Percutaneous Endoscopic Discectomy.
AIM
To investigate and compare the therapeutic efficiency and radiographic measurement between the transforaminal approach and interlaminar approach in percutaneous endoscopic discectomy.
MATERIAL AND METHODS
From January 2017 to January 2018, 86 patients suffering from single lumbar disc herniation were included in this retrospective analysis and divided into the percutaneous endoscopic transforaminal discectomy (PETD) group and percutaneous endoscopic interlaminar discectomy (PEID) group according to different surgical approaches. Data on age, gender, course of the disease, smoking status, and body mass index (BMI) were also obtained. Moreover, lumbar spine X-ray (anterior? posterior, lateral, and excessive flexion and extension), CT scan, and MRI were performed preoperatively for all patients. Another MRI of the lumbar spine was performed within the week after the operation. Clinical efficacy was calculated to assess the clinical effect of the therapy using the visual analogue scale (VAS) and Oswestry Disability Index (ODI) at 1 day before surgery, 3 months after surgery, 1 year after surgery, and the last follow-up visit.
RESULTS
All patients were followed up for above two year. 44 and 42 cases were enrolled, respectively, in the PETD and PEID groups. 62 males and 24 females were included in this study. The mean ages of the PETD and PEID groups were 34.58 ± 6.70 and 33.72 ± 7.12 years, respectively (p=0.763). The symptoms showed evident improvement after surgery, but there were no significant differences regarding VAS scores, ODI scores, spinal canal occupation rate and lumbar lordosis except disc height and pfirrmann grade between the two groups (p > 0.05). The revision surgery rates of the PETD and PEID groups at the last follow-up time were 2.3% and 4.8%, respectively (p=0.612). One patient in the PETD group underwent PEID revision surgery because of residual disk herniation. Re-operation were performed on 2 patients in the PEID group due to recurrencee.
CONCLUSION
Approaches of the PEID and PETD are pivotal to address lumbar disc herniation (LDH) disease. Selection of surgery approach depends on anatomical structure, physiological characteristic and operative skill of the surgeon.
Topics: Adult; Diskectomy; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Degeneration; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Retrospective Studies; Treatment Outcome
PubMed: 33759158
DOI: 10.5137/1019-5149.JTN.30241-20.4 -
BMC Musculoskeletal Disorders May 2023Anteroposterior (AP) and lateral fluoroscopies are often used to evaluate the intraoperative location and angulation of the trajectory in percutaneous endoscopic...
BACKGROUND
Anteroposterior (AP) and lateral fluoroscopies are often used to evaluate the intraoperative location and angulation of the trajectory in percutaneous endoscopic transforaminal lumbar discectomy (PETLD). Although the location of the trajectory shown in fluoroscopy is absolutely accurate, the angulation is not always reliable. This study aimed to evaluate the accuracy of the angle shown in the AP and lateral fluoroscopic views.
METHODS
A technical study was performed to assess the angulation errors of PETLD trajectories shown in AP and lateral fluoroscopic views. After reconstructing a lumbar CT image, a virtual trajectory was placed into the intervertebral foramen with gradient-changing coronal angulations of the cephalad angle plane (CACAP). For each angulation, virtual AP and lateral fluoroscopies were taken, and the cephalad angles (CA) of the trajectory shown in the AP and lateral fluoroscopic views, which indicated the coronal CA and the sagittal CA, respectively, were measured. The angular relationships among the real CA, CACAP, coronal CA, and sagittal CA were further demonstrated with formulae.
RESULTS
In PETLD, the coronal CA is approximately equal to the real CA, with a small angle difference and percentage error, whereas the sagittal CA shows a rather large angle difference and percentage error.
CONCLUSION
The AP view is more reliable than the lateral view in determining the CA of the PETLD trajectory.
Topics: Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Endoscopy; Fluoroscopy; Diskectomy, Percutaneous
PubMed: 37231389
DOI: 10.1186/s12891-023-06564-x -
Medicine Nov 2021Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED), as two alternative surgical techniques in minimally invasive spine surgery...
Comparison of microendoscopic discectomy and percutaneous transforaminal endoscopic discectomy for upper lumbar disc herniation: A protocol for a systematic review and meta-analysis.
BACKGROUND
Microendoscopic discectomy (MED) and percutaneous transforaminal endoscopic discectomy (PTED), as two alternative surgical techniques in minimally invasive spine surgery (MISS), are widely conducted in the treatment of upper lumbar disc herniation (ULDH). This study will systematically assess and compare the clinical outcomes of MED and PTED in treating ULDH combining with the meta-analysis.
METHODS
All the randomized controlled trials (RCTs) will be searched at the databases including PubMed, EMBASE, Cochrane Library and Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP), and WANFANG Database from inception to December 2025. The primary outcome will involve Japanese Orthopedic Association (JOA), Oswestry disability index (ODI), and visual analog scale (VAS) scores. The secondary outcomes will be the short-form 36-item (SF-36) health survey questionnaire and the modified MacNab criterion. We will perform data synthesis, subgroup analysis, sensitivity analysis, meta-regression analysis, and the assessment of reporting bias using RevMan 5.3 software.
RESULTS
This systematic review will comprehensively evaluate the clinical outcomes of comparison of MED and PTED in the treatment of ULDH and provide a reliable and high-quality evidence.
CONCLUSION
The conclusion of this study will elucidate the clinical outcomes of MED compared with PTED and clarify whether PTED generates better clinical effects than MED in treating ULDH.
PROSPERO REGISTRATION NUMBER
CRD 42021244204.
Topics: Diskectomy; Diskectomy, Percutaneous; Endoscopy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Meta-Analysis as Topic; Systematic Reviews as Topic; Treatment Outcome
PubMed: 34797347
DOI: 10.1097/MD.0000000000027914