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Journal of Orthopaedic Surgery and... Jun 2021Percutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disc herniation (LDH) due to its...
Application of a targeted and quantificational foraminoplasty device in percutaneous transforaminal endoscopic discectomy for L5-S1 disc herniation: preliminary clinical outcomes.
OBJECTIVE
Percutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disc herniation (LDH) due to its safety and efficiency. However, due to the unique anatomy of the L5-S1 level, the PTED procedure is often difficult to perform in the region. ZESSYS, a targeted and quantificational foraminoplasty device, may help to overcome these anatomical limitations. In this study, we assessed the efficiency and the short-term effects of PTED with ZESSYS at the L5-S1 level.
METHODS
Between January and August of 2018, fifty-six patients with lumbar disc herniation at the single level of L5-S1 and who underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the transforaminal endoscopic surgical system (TESSYS) group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time, and fluoroscopy time were evaluated for operation efficiency. Clinical outcomes were assessed by the visual analog scale (VAS) score and Oswestry Disability Index (ODI) score. The MacNab criteria were used to evaluate patient subjective satisfaction at 12-month follow-up postoperatively.
RESULTS
The average puncture time (5.29 ± 2.05 min), foraminoplasty time (12.82 ± 2.52 min), and fluoroscopy time (26.29 ± 5.96 s) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07 ± 3.13 min, p < 0.01; foraminoplasty time, 17.18 ± 2.92 min, p < 0.01; fluoroscopy time, 34.73 ± 6.86 s; p < 0.01). No significant differences were observed between the 2 groups in the decompression time (p = 0.057). The VAS score of low back pain and leg pain, as well as the ODI score, improved at all time points postoperatively compared with preoperative, in both the TESSYS group and the ZESSYS group (P < 0.05). There were no significant differences in the VAS score of low back pain, VAS score of leg pain, and ODI score between the TESSYS group and the ZESSYS group at the same time points (P > 0.05). According to the MacNab criteria, the excellent and good rate at 12-month follow-up postoperatively was 85.7% in the TESSYS group and 89.3% in the ZESSYS group (P > 0.05).
CONCLUSION
The targeted and quantificational foraminoplasty device named ZESSYS was more efficient in the puncture and foraminoplasty procedures, effectively protecting the exiting nerve and minimizing the level of radiation exposure. The device is efficient and safe for PTED in treating lumbar disc herniation at the L5-S1 level.
Topics: Disability Evaluation; Diskectomy, Percutaneous; Endoscopy; Female; Foraminotomy; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Retrospective Studies; Sacrum; Spinal Canal; Treatment Outcome
PubMed: 34158087
DOI: 10.1186/s13018-021-02533-z -
Pain Physician Jan 2023Recurrence of lumbar disc herniation (LDH) is an adverse event after percutaneous endoscopic transforaminal discectomy (PETD). Accurate prediction of the risk of...
BACKGROUND
Recurrence of lumbar disc herniation (LDH) is an adverse event after percutaneous endoscopic transforaminal discectomy (PETD). Accurate prediction of the risk of recurrent LDH (rLDH) after surgery remains a major challenge for spine surgeons.
OBJECTIVES
To develop and validate a prognostic model based on risk factors for rLDH after PETD.
STUDY DESIGN
Retrospective study.
SETTING
Inpatient surgery center.
METHODS
Clinical data were retrospectively collected from 645 patients with LDH who underwent PETD at the Affiliated Hospital of Xuzhou Medical University from January 1, 2017 to January 1, 2021. Predictors significantly associated with rLBH were screened according to least absolute shrinkage and selection operator (LASSO) regression, and a prognostic model was established, followed by internal model validation using the enhanced bootstrap method. The performance of the model was assessed using receiver operating characteristic (ROC) curves and calibration curves. Finally, the clinical usefulness of the model was analyzed using decision curve analysis (DCA) and clinical impact curves (CICs).
RESULTS
Among the 645 patients included in this study, 56 experienced recurrence of LDH after PETD (8.7%). Seven factors significantly associated with rLDH were selected by LASSO regression, including age, type of herniation, level of herniation, Modic changes, Pfirrmann classification, smoking, and history of high-intensity physical work. The bias-corrected curve of the model fit well with the apparent curve, and the area under the ROC curve was 0.822 (95% confidence interval, 0.76-0.88). The DCA and CIC confirmed that the prognostic model had good clinical utility.
LIMITATIONS
This is a single-center study, and we used internal validation only.
CONCLUSIONS
The prognostic model developed in this study had excellent comprehensive performance and could well predict the risk of rLDH after PETD. This model could be used to identify patients at high risk for rLDH at an early stage to individualize the patient's treatment modality and postoperative rehabilitation plan.
Topics: Humans; Intervertebral Disc Displacement; Retrospective Studies; Prognosis; Treatment Outcome; Lumbar Vertebrae; Diskectomy, Percutaneous; Diskectomy; Endoscopy
PubMed: 36791297
DOI: No ID Found -
Revista Da Associacao Medica Brasileira... Jul 2019To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with...
OBJECTIVE
To investigate the efficacy and safety of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar spinal stenosis (LSS) combined with osteoporosis.
METHODS
Eighty patients with LSS combined with osteoporosis were divided into a control and PTED group, which received conventional transforaminal lumbar interbody fusion and PTED, respectively. The surgical indications, incision visual analogue scale (VAS), lumbar and leg pain VAS, lumbar Japanese Orthopaedic Association (JOA) and Oswestry disability index (ODI) scores, bone mineral density (BMD), and adverse reactions were observed.
RESULTS
Compared with the control group, in the PTED group, the operation time, bleeding loss and hospitalization duration, incision VAS scores at postoperative 12, 24 and 48 h and lumbar and leg pain VAS and lumbar ODI scores on postoperative 6 months were significantly decreased (P < 0.01), and the lumbar JOA score on postoperative 6 months was significantly increased (P < 0.05). There was no significant difference in BMD between two groups (P > 0.05). Compared with the control group, in the PTED group, the total effective rate was significantly higher (P < 0.05), and the incidence of adverse reactions was significantly lower (P < 0.05).
CONCLUSIONS
PTED is safe and effective in the treatment of LSS combined with osteoporosis.
Topics: Aged; Aged, 80 and over; Bone Density; Disability Evaluation; Diskectomy, Percutaneous; Humans; Lumbar Vertebrae; Middle Aged; Osteoporosis; Postoperative Care; Reproducibility of Results; Spinal Stenosis; Time Factors; Treatment Outcome; Visual Analog Scale
PubMed: 31340304
DOI: 10.1590/1806-9282.65.6.779 -
The Cochrane Database of Systematic... Apr 2007Disc prolapse accounts for five percent of low-back disorders but is one of the most common reasons for surgery. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Disc prolapse accounts for five percent of low-back disorders but is one of the most common reasons for surgery.
OBJECTIVES
The objective of this review was to assess the effects of surgical interventions for the treatment of lumbar disc prolapse.
SEARCH STRATEGY
We searched the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Spine and abstracts of the main spine society meetings within the last five years. We also checked the reference lists of each retrieved articles and corresponded with experts. All data found up to 1 January 2007 are included.
SELECTION CRITERIA
Randomized trials (RCT) and quasi-randomized trials (QRCT) of the surgical management of lumbar disc prolapse.
DATA COLLECTION AND ANALYSIS
Two review authors assessed trial quality and extracted data from published papers. Additional information was sought from the authors if necessary.
MAIN RESULTS
Forty RCTs and two QRCTs were identified, including 17 new trials since the first edition of this review in 1999. Many of the early trials were of some form of chemonucleolysis, whereas the majority of the later studies either compared different techniques of discectomy or the use of some form of membrane to reduce epidural scarring. Despite the critical importance of knowing whether surgery is beneficial for disc prolapse, only four trials have directly compared discectomy with conservative management and these give suggestive rather than conclusive results. However, other trials show that discectomy produces better clinical outcomes than chemonucleolysis and that in turn is better than placebo. Microdiscectomy gives broadly comparable results to standard discectomy. Recent trials of an inter-position gel covering the dura (five trials) and of fat (four trials) show that they can reduce scar formation, though there is limited evidence about the effect on clinical outcomes. There is insufficient evidence on other percutaneous discectomy techniques to draw firm conclusions. Three small RCTs of laser discectomy do not provide conclusive evidence on its efficacy, There are no published RCTs of coblation therapy or trans-foraminal endoscopic discectomy.
AUTHORS' CONCLUSIONS
Surgical discectomy for carefully selected patients with sciatica due to lumbar disc prolapse provides faster relief from the acute attack than conservative management, although any positive or negative effects on the lifetime natural history of the underlying disc disease are still unclear. Microdiscectomy gives broadly comparable results to open discectomy. The evidence on other minimally invasive techniques remains unclear (with the exception of chemonucleolysis using chymopapain, which is no longer widely available).
Topics: Cicatrix; Diskectomy; Humans; Intervertebral Disc Chemolysis; Intervertebral Disc Displacement; Lumbar Vertebrae; Randomized Controlled Trials as Topic
PubMed: 17443505
DOI: 10.1002/14651858.CD001350.pub4 -
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 -
Medicine Jul 2018The authors retrospectively characterized the clinical outcomes of combining the Yeung endoscopic spine system (YESS) and transforaminal endoscopic surgical system...
The authors retrospectively characterized the clinical outcomes of combining the Yeung endoscopic spine system (YESS) and transforaminal endoscopic surgical system (TESSYS) techniques during percutaneous transforaminal endoscopic discectomy (PTED) to treat multilevel lumbar disc herniation.PTED using both YESS and TESSYS was performed on 52 patients with multilevel lumbar disc herniations who had shown no apparent response to previous conservative treatments. Postsurgical follow-ups were conducted at weeks 1, 26, and 48. Patients' preoperative and postoperative performances were assessed by modified MacNab classification, Japanese Orthopedic Association (JOA) scores, Oswestry disability index (ODI), and visual analog scale (VAS), and compared with 34 and 45 patients who were treated only by YESS and TESSYS, respectively.The postsurgery surgeon-performed assessment showed satisfactory results in 98% of the YESS + TESSYS-treated cases. The average operative time was 116 ± 23 minutes, intraoperative bleeding was 19 ± 12 mL, and bed stay was 3 days. No complications occurred, including infection, nerve injury, or spinal canal hematoma. One week after surgery, the modified MacNab classifications of the patients were excellent in 45, good in 6, fair in 1, and poor in 0 (98% were excellent or good). JOA, ODI, and VAS scores for low back pain significantly improved relative to the preoperative assessment (P < .01) and had remained stable at 26 and 48 weeks.PTED that combined YESS and TESSYS techniques, depending on the predominant type of lumbar disc herniation at individual levels, is safe, minimally invasive, and effective.
Topics: Aged; Disability Evaluation; Diskectomy, Percutaneous; Endoscopy; Female; Humans; Intervertebral Disc Displacement; Low Back Pain; Lumbar Vertebrae; Male; Middle Aged; Outcome and Process Assessment, Health Care; Postoperative Complications; Recovery of Function; Severity of Illness Index; Visual Analog Scale
PubMed: 29995758
DOI: 10.1097/MD.0000000000011240 -
Orthopaedic Surgery Dec 2021After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg...
OBJECTIVE
After percutaneous endoscopic lumbar discectomy (PELD), most patients with lumbar disc herniation (LDH) experience relief from the typical symptoms of low back and leg pain. However, for a small number of patients, these symptoms are relieved immediately after surgery but aggravated soon after, and then relieved after short-term full rest or conservative treatment. The aim of the study was to demonstrate this short-term recurrent phenomenon, termed rebound pain.
METHODS
A retrospective study was conducted on 144 patients who underwent single-segment PELD from May 2017 to June 2020. Postoperative patients were divided into a rebound pain group and a non-rebound pain group. For the former group, general information, symptom characteristics and visual analogue score (VAS) changes in rebound pain were summarized. For both groups, postoperative efficacy was evaluated by recent VAS of low back and leg pain in the remission stage, the Oswestry disability index (ODI) and the modified MacNab criteria at the last follow-up. Logistic regression analysis was used to identify predictors for rebound pain.
RESULTS
The VAS and ODI exhibited significant improvements at the last follow-up of average 15.4 months (P < 0.001). The successful outcomes according to the modified MacNab criteria reached 94.4%. A total of 15 patients (10.4%) experienced rebound pain. The typical feature was pain that usually began within 1 month after surgery and lasted for less than 1 month. The symptoms were mainly leg pain with or without low back pain. The range of pain was equal to or less than that before surgery. The symptoms were relieved after conservative treatment. In logistic regression model, postoperative return-to-work time > 45 days was found as a protective factor for rebound pain (p = 0.031).
CONCLUSION
Although rebound pain with multiple characteristics and a short duration had no significant effect on long-term postoperative efficacy, its high incidence often caused unnecessary concern in both patients and doctors. As a result, careful differentiation of rebound pain from other postoperative complications is needed.
Topics: Adult; Disability Evaluation; Diskectomy, Percutaneous; Female; Humans; Intervertebral Disc Displacement; Lumbar Vertebrae; Male; Middle Aged; Pain Measurement; Pain, Postoperative; Retrospective Studies
PubMed: 34643334
DOI: 10.1111/os.13088 -
BMC Musculoskeletal Disorders Jun 2024Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of... (Comparative Study)
Comparative Study
BACKGROUND
Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of patients with ULDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) compared with those with lower LDH.
METHODS
60 patients with ULDH or L4-L5 LDH treated with PTED between May 2016 and October 2021. MacNab criteria, visual analog scale (VAS) of back pain and leg pain, and Japanese Orthopedic Association (JOA) were evaluated before and after surgery.
RESULTS
In the L1-L3 group, 59.1% of the patients had a positive femoral nerve tension test, and 81.8% of the patients had a sensory deficit. Both groups showed significant improvements in VAS scores for low back and leg pain, and JOA scores postoperatively. No significant differences in the degree of improvement were observed between the two groups. The excellent/good rate was 81.8% in the L1-L3 group and 84.2% in the L4-L5 group, showing no significant difference.
CONCLUSION
PTED has comparable efficacy in treating ULDH as it does in treating lower LDH, it is a safe and effective treatment method for ULDH.
Topics: Humans; Intervertebral Disc Displacement; Male; Diskectomy, Percutaneous; Female; Lumbar Vertebrae; Middle Aged; Adult; Treatment Outcome; Endoscopy; Retrospective Studies; Pain Measurement; Aged
PubMed: 38879478
DOI: 10.1186/s12891-024-07588-7 -
Journal of Orthopaedic Surgery and... Jul 2020The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic... (Observational Study)
Observational Study
Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in vitro experiment.
PURPOSE
The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD).
METHODS
Clinical research and in vitro experiment are combined. In the in vitro experiment, 2.0-ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the direct measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disk herniation were treated with PELD, and HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤ 10 ml) and group B (> 10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS), and Oswestry Disability Index (ODI) scores were compared between the two groups.
RESULTS
In the in vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P < 0.05). There was a significant difference between group A and group B in blood loss (7.40 ± 1.61 vs 19.91 ± 10.94 ml), operation time (80.51 ± 34.70 vs 136.51 ± 41.88 min), and fluoroscopy frequency (6.92 ± 1.52 vs 11.11 ± 2.32 times) (P < 0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P < 0.05); however, the scores were not different between the two groups at pre-operation (P > 0.05).
CONCLUSION
HCT-M is a reliable method to estimate endoscopic blood loss in PELD. The amount of endoscopic blood loss affects the operative procedure in operation time and fluoroscopy frequency, as well as clinical effects in VAS and ODI scores after operation in short term.
Topics: Blood Loss, Surgical; Blood Volume; Diskectomy, Percutaneous; Endoscopy; Erythrocyte Count; Fluoroscopy; Hematocrit; Hemostasis, Endoscopic; Humans; In Vitro Techniques; Intervertebral Disc; Intervertebral Disc Degeneration; Intraoperative Period; Lumbar Vertebrae; Operative Time; Pain Management; Time Factors; Visual Analog Scale
PubMed: 32711563
DOI: 10.1186/s13018-020-01797-1 -
Pain Physician 2009Since the descriptions by Mixter and Barr of open surgical treatment for rupture of the intervertebral disc in 1934, open surgical procedures have become a common... (Review)
Review
BACKGROUND
Since the descriptions by Mixter and Barr of open surgical treatment for rupture of the intervertebral disc in 1934, open surgical procedures have become a common practice. Disc herniations have been reported as being contained and non-contained. The results of open surgical discectomy for contained disc herniation have been poor. Consequently, several alternative techniques have been developed which are minimally invasive including percutaneous laser disc decompression.
STUDY DESIGN
A systematic review of the literature.
OBJECTIVE
The objective of this systematic review is to evaluate the clinical effectiveness of percutaneous laser discectomy in managing radicular pain secondary to contained disc herniation.
METHODS
A comprehensive evaluation of the literature relating to mechanical disc decompression was performed. The literature was evaluated according to Cochrane review criteria for randomized controlled trials (RCTs), and Agency for Healthcare Research and Quality (AHRQ) criteria was utilized for observational studies. A literature search was conducted by using only the English language literature through PubMed, EMBASE, the Cochrane library, systematic reviews, and cross references from reviews and systematic reviews. The level of evidence was classified as Level I, II, or III with 3 subcategories in Level II based on the quality of evidence developed by the United States Preventive Services Task Force (USPSTF).
OUTCOME MEASURES
Pain relief was the primary outcome measure. Other outcome measures were functional improvement, improvement of psychological status, opioid intake, and return to work. Short-term effectiveness was defined as one year or less, whereas, long-term effectiveness was defined as greater than one year.
RESULTS
Based on USPSTF criteria the indicated level of evidence for percutaneous lumbar laser discectomy (PLLD) is II-2 for short- and long-term relief.
LIMITATIONS
Even though laser discectomy has been in utilization for a number of years and numerous procedures have been performed there continues to be a paucity of literature of randomized clinical trials.
CONCLUSION
This systematic review illustrates Level II-2 evidence for percutaneous laser disc decompression which is equivalent to automated percutaneous lumbar disc decompression.
Topics: Diskectomy, Percutaneous; Humans; Intervertebral Disc; Intervertebral Disc Displacement; Laser Therapy; Low Back Pain; Lumbar Vertebrae; Outcome Assessment, Health Care; Radiculopathy; Time; Treatment Outcome
PubMed: 19461824
DOI: No ID Found