Poster 173: Therapeutic Outcomes of Integrative Treatment Package for Surgical Candidates with Lumbar Disk Herniation (1-Year Follow up)

Abstract ObjectivePercutaneous transforaminal endoscopic discectomy (PTED) is minimally invasive and has been widely used to treat patients with lumbar disk 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 ZESSY at the L5-S1 level.MethodsBetween January to August of 2018, Fifty-six patients with lumbar disk herniation at the single level of L5–S1 and underwent percutaneous transforaminal endoscopic discectomy were enrolled in this retrospective cohort study. They were segregated into the the TESSYS group and the ZESSYS group. The puncture time, foraminoplasty time, decompression time and fluoroscopy time evaluated for the operation efficiency. Clinical outcomes were assessed by 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.ResultsThe average puncture time (5.29±2.05 minutes), foraminoplasty time (12.82±2.52 minutes) and fluoroscopy time (26.29±5.96 seconds) were all significantly shorter in the ZESSYS group than in the TESSYS group (average puncture time 8.07±3.13 minutes, p<0.01; foraminoplasty time, 17.18±2.92 minutes, p<0.01; fluoroscopy time, 34.73±6.86 seconds; 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 preoprative , 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).ConclusionThe 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 disk herniation at the L5-S1 level.

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Outcome Predictors of the Transforaminal Endoscopic Spine System Technique for Single-level Lumbar Disk Herniation

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0038-1639503 ◽

2018 ◽

Vol 79 (04) ◽

pp. 285-290 ◽

Cited By ~ 4

Author(s):

Jinchun Wu ◽

Bin Yu ◽

Bin He ◽

Gang Liu ◽

Jidong Ju ◽

...

Keyword(s):

Multivariate Analyses ◽

Symptomatic Improvement ◽

Older Age ◽

Outcome Predictors ◽

Disk Herniation ◽

Lumbar Disk Herniation ◽

Lumbar Disk ◽

Endoscopic Spine Surgery ◽

High Intensity Zone

Background Endoscopic spine surgery has become increasingly popular. However, no study has researched the predictive factors for different outcomes. This study is the first to evaluate the outcome predictors of the transforaminal endoscopic spine system (TESSYS) technique for lumbar disk herniation (LDH). Methods We performed a prospective study of 80 patients meeting the inclusion criteria who underwent TESSYS for LDH. Clinical outcomes were assessed by the visual analog scale (VAS), the Oswestry Disability Index (ODI), and the modified MacNab criteria. Univariate and multivariate analyses were performed to evaluate the outcome predictors. Results There were 36 men and 44 women with a mean age of 48.76 ± 15.60 years (range: 24–78 years). The mean follow-up time was 25.15 ± 9.76 months (range: 12–48 months). The VAS and ODI scores at the last follow-up were significantly improved (p < 0.001). Based on the modified MacNab criteria, the global outcomes were excellent in 34 patients (42.5%), good in 26 patients (32.5%), fair in 11 patients (13.75%), and poor in 9 patients (11.25%). The percentage of symptomatic improvement was 88.75%, and the success rate (excellent or good) was 75%. In the univariate and multivariate analyses, LDH with older age (odds ratio [OR]: 6.621; 95% confidence interval [CI], 0.632–20.846; p = 0.019), high-intensity zone (HIZ) (OR: 8.152; 95% CI, 0.827–4.380; p = 0.003), and larger disk herniation (OR: 6.819; 95% CI, 0.113–4.825; p = 0.017) were the most significant negative outcome predictors. Conclusions TESSYS is an effective method to treat LDH. Older age, the existence of an HIZ, and a large disk herniation were the most important predictors for a worse outcome.

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Long-term Outcome After Microendoscopic Diskectomy for Lumbar Disk Herniation: A Prospective Clinical Study With a 5-Year Follow-up

Neurosurgery ◽

10.1227/neu.0b013e31820cd16a ◽

2011 ◽

Vol 68 (6) ◽

pp. 1568-1575 ◽

Cited By ~ 40

Author(s):

Roberto Casal-Moro ◽

Manuel Castro-Menéndez ◽

Moisés Hernández-Blanco ◽

Jose A. Bravo-Ricoy ◽

Francisco J. Jorge-Barreiro

Keyword(s):

Oswestry Disability Index ◽

Disk Herniation ◽

Lumbar Disk Herniation ◽

Term Outcome ◽

Long Term Outcome ◽

Lumbar Disk ◽

Oswestry Disability Index Score ◽

The Mean

Abstract BACKGROUND: Several authors have reported results obtained with the microendoscopic diskectomy (MED) technique, but the long-term outcome has not been described. This report summarizes our clinical experience with the lumbar MED technique with a long-term follow-up period. OBJECTIVE: To evaluate the efficacy of the MED for lumbar disk herniation and to report long-term outcome and complications (5-year follow-up). METHODS: One hundred twenty consecutive patients with lumbar disk herniation were treated with the METRx system.We included all types of lumbar herniated disks: contained, not contained, foraminal, and migrated disk herniations. The results were evaluated with the Visual Analog Scale (VAS) pain score, Oswestry Disability Index score, patient satisfaction questionnaire, and modified Macnab criteria. RESULTS: The average age of patients was 41 years; 65 were men and 55 were women. The most commonly affected level was L5-S1 (54.2%). The follow-up time after surgery was 5 years in all cases. We obtained good or excellent results in 75% of patients and regular results in 18%. Good subjective satisfaction was observed with surgery in 92% of patients. The mean decrease in the Oswestry Disability Index score was 52.8 ± 21.6; the mean decrease in leg VAS score was 6.1 ± 2.3; and the mean decrease in lumbar VAS score was 1.9 ± 3.3. Adjusted mean differences were statistically significant in all cases (P < .05). CONCLUSION: MED not only reduces the incision, tissue damage, and postoperative period of incapacity but also offers long-term results comparable to those of conventional techniques.

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Surgical Outcomes of Extraforaminal Microdiskectomy by Midline Incision for Far-Lateral Lumbar Disk Herniation

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0040-1714367 ◽

2020 ◽

Vol 82 (01) ◽

pp. 027-033

Author(s):

Ismail Yüce ◽

Okan Kahyaoğlu ◽

Halit Çavuşoğlu ◽

Yunus Aydın

Keyword(s):

Surgical Outcomes ◽

Magnetic Resonance Images ◽

Disk Herniation ◽

Midline Incision ◽

Lumbar Disk Herniation ◽

Invasive Approach ◽

Lumbar Disk ◽

Far Lateral ◽

The Mean

Abstract Background Far-lateral lumbar disk herniation (FLDH) is defined as a disk herniation located laterally to the medial wall of the pedicle. The aim of our study is to describe the extraforaminal microdiskectomy by midline incision for FLDH, which does not include laminotomy–partial facetectomy, and to evaluate mid-term surgical outcomes. Methods 107 patients who underwent surgery for FLDH by midline incision for the first time between 2012 and 2017 were included in our study. The assessment of neurological status of the patients was done by physical examination, preoperative Oswestry Disability Index (ODI), Visual Analog Scala (VAS) scores, and magnetic resonance images. They were then followed-up postoperatively and at 12 months with VAS and ODI tests. Result 58 (54.2%) patients were male and 49 (45.8%) were female. The mean age at the time of surgery was 55.0 ± 8.6 years. The mean ODI scale score was 32.4 ± 6.2 preoperatively, 11.4 ± 2.1 early postoperatively, and 9.7 ± 2.2 in late postoperative follow-up (statistically significant, p = 0.001). The average VAS was 7.51 ± 1.1 preoperatively, 2.74 ± 0.7 early postoperatively, and 0.68 ± 0.08 in late postoperative follow-up (statistically significant, p = 0.001). The average operative time was 41 ± 7 (37 to 58) minutes. Conclusions The extraforaminal microdiskectomy without laminotomy by midline incision is a minimally invasive approach for FLDH. Our technique allows a sufficient and safe decompression of the neural structures, and thus results in a significant reduction of the symptoms and disability

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Analysis of the clinical effects of transforaminal endoscopic discectomy on lumbar disk herniation combined with common peroneal nerve paralysis: a 2-year follow-up retrospective study on 32 patients

Journal of Pain Research ◽

10.2147/jpr.s120463 ◽

2017 ◽

Vol Volume 10 ◽

pp. 105-112 ◽

Cited By ~ 1

Author(s):

Yapeng Wang ◽

Wei Zhang ◽

Jian Zhang ◽

Yapeng Sun ◽

Jilong An ◽

...

Keyword(s):

Retrospective Study ◽

Peroneal Nerve ◽

Common Peroneal Nerve ◽

Clinical Effects ◽

Disk Herniation ◽

Lumbar Disk Herniation ◽

Nerve Paralysis ◽

Lumbar Disk ◽

Endoscopic Discectomy

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Biportal Endoscopic Lumbar Decompression for Lumbar Disk Herniation and Spinal Canal Stenosis: A Technical Note

Journal of Neurological Surgery Part A Central European Neurosurgery ◽

10.1055/s-0036-1592157 ◽

2016 ◽

Vol 78 (04) ◽

pp. 390-396 ◽

Cited By ~ 12

Author(s):

Jin Eum ◽

Sang Lee ◽

Luigi Sabal ◽

Sang Eun

Keyword(s):

Spinal Canal ◽

Technical Note ◽

Disk Herniation ◽

Lumbar Disk Herniation ◽

Lumbar Disk ◽

Lumbar Decompression ◽

Canal Stenosis ◽

Lumbar Disk Herniations ◽

Lumbar Spinal

Background and Study Aims Endoscopic lumbar diskectomy through the interlaminar window is gaining recognition. Most of the literature describes these endoscopic procedures using specialized uniportal multichannel endoscopes. However, a single portal limits the motion of the instruments and obscures visualization of the operating field. To overcome this limitation, we propose a new technique that utilizes two portals to access the spinal canal. The biportal endoscopic lumbar decompression (BELD) technique uses two portals to treat difficult lumbar disk herniations and also lumbar spinal stenoses. Patients and Methods Seventeen patients were treated with BELD for 11 lumbar disk herniations and 6 lumbar spinal stenoses. Preoperative back and leg visual analog scale (VAS-B and VAS-L, respectively) scores and the Oswestry Disability Index (ODI) were recorded and compared with corresponding values on final follow-up. Results There was an average follow-up of 14 months. For the disk herniation group, preoperative VAS-L (7.8750 ± 1.24) and ODI (51.73 ± 18.57) was significantly different from follow-up postoperative VAS-L (0.87 ± 0.64, p = 0.000) and ODI (9.37 ± 4.83, p = 0.001). For the stenosis group, preoperative VAS-B (6.17 ± 1.94), VAS-L(7.83 ± 1.47), and ODI (63.27 ± 7.67) were significantly different from follow-up postoperative values (2.5 ± 1.04, p = 0.022; 2.00 ± 1.67, p = 0.001; 24.00 ± 6.45, p = 0.000, respectively). One patient underwent revision microdiskectomy for incomplete decompression. Conclusions BELD can achieve a similar decompression effect as microdiskectomy and unilateral laminotomy for bilateral decompression with a smaller incision than tubular diskectomy.

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