Lumbosacral Transitional Vertebrae in Adolescents: Effects on the Short-Term Outcomes of Percutaneous Endoscopic Lumbar Discectomy

Objective. To investigate whether lumbosacral transitional vertebrae (LSTV) affects the clinical outcomes of percutaneous endoscopic lumbar discectomy (PELD) in adolescent patients with lumbar disc herniation (LDH). Methods. This was a retrospective study with two groups. Group A was made up of 22 adolescent LDH patients with LSTV (18 males and 4 females). Group B was made up of 44 adolescent LDH patients without LSTV (36 males and 4 females), who were matched to group A for age, sex, and body mass index. All patients underwent PELD at the L4/5 or L5/S1 single level and were followed up at 18 months after surgery. We identified LSTV on radiographs and computed tomography and assessed the imaging characteristics of all patients. Outcomes were evaluated through a numerical rating scale (NRS), the Oswestry Disability Index (ODI), the modified MacNab grading system, and the incidence of additional lumbar surgery. Results. At 18 months after PELD, both groups had significant improvements in the mean NRS scores of low back pain (LBP) or leg pain and the ODI scores. In terms of the MacNab criteria, 90.9% in group A and 93.2% in group B showed excellent or good outcomes. The mean NRS scores of LBP or leg pain, ODI score, and MacNab grade after surgery were not significantly different between the 2 groups. Two patients (one patient had a recurrence; one patient had a new lumbar disc herniation) in group A and 3 patients (one patient had a recurrence; two patients had new lumbar disc herniations) in group B underwent additional lumbar surgery. Conclusions. Our study suggests that in terms of pain relief, life function improvement, and the incidence of additional lumbar surgery, LSTV has no effect on the short-term clinical outcomes of PELD in adolescents. A new lumbar disc herniation is an important reason for additional surgery in adolescents, regardless of the LSTV status.

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Open Fenestration Discectomy Versus Microscopic Fenestration Discectomy for Lumbar Disc Herniation: a randomized controlled trial

10.21203/rs.3.rs-16951/v2 ◽

2020 ◽

Author(s):

Sherwan Hamawandi ◽

Injam Ibrahim Sulaiman ◽

Ameer Kadhim Al-Humairi

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Oswestry Disability Index ◽

Lumbar Disc ◽

Daily Activities ◽

Leg Pain ◽

Group A ◽

Group B ◽

Type Of Surgery

Abstract Background: Fenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.Methods: 60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years. Results: In both groups, all patients have minimal disability by Oswestry Disability Index after surgery.There were significant differences between means of post-operative VAS for back pain between these two groups after one weeks (3.7 in group A versus 2.2 in group B) (t= 13.28, P=<0.001٭) and after 3 months (1.73 in group A versus 0.43 in group B) (t=10.54, P=<0.001٭).There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group).There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P<0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P<0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P<0.001).Conclusion: Use of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.Trial registration: NCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485

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Hybrid Interlaminar Endoscopic Lumbar Decompression in Disc Herniation Combined With Spinal Stenosis

Operative Neurosurgery ◽

10.1093/ons/opaa360 ◽

2020 ◽

Author(s):

Kuo-Tai Chen ◽

Kyung-Chul Choi ◽

Myung-Soo Song ◽

Hussam Jabri ◽

Yadhu K Lokanath ◽

...

Keyword(s):

Spinal Stenosis ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Leg Pain ◽

Lumbar Decompression ◽

Lateral Recess Stenosis ◽

Endoscopic Discectomy ◽

The Mean

Abstract BACKGROUND Endoscopic spine surgery is an alternative to the traditional treatment of lumbar disc herniation. However, the traditional technique of interlaminar endoscopic approach is challenging and risky in patients with concomitant spinal stenosis. OBJECTIVE To report a modified technique called hybrid interlaminar endoscopic lumbar decompression as an effective treatment. METHODS Patients with combined lumbar disc herniation and lateral recess stenosis undergoing full-endoscopic interlaminar lumbar discectomy were retrospectively studied. The hybrid interlaminar endoscopic discectomy technique, as well as the use of 2 endoscopes with different diameters, is described in detail. The large endoscope is used for the laminotomy procedure, while the small endoscope is used for the discectomy procedure. The demographics and clinical outcomes of the patients are presented. RESULTS A total of 19 patients were included in this study. The mean age was 46.7 yr. The visual analog scale for back and leg pain improved from 5.6 ± 3.4 and 7.5 ± 2.3 to 1.8 ± 1.3 and 1.8 ± 1.6, respectively (P < .001). The mean Oswestry Disability Index improved from 59.9 ± 21.2 preoperatively to 18.2 ± 8.5 postoperatively (P < .001). The follow-up was 8.2 mo on average. No major complications occurred, but 2 patients reported mild postoperative paresthesia. One patient had an early recurrence and underwent repeat endoscopic discectomy. CONCLUSION Full-endoscopic lumbar discectomy provides excellent access to the intracanalicular herniation site of an intervertebral disc. By using the endoscopic technique presented here, surgeons can safely and efficiently achieve adequate decompression in patients with lumbar disc herniation combined with spinal stenosis.

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Comparison of Conventional Fenestration Discectomy Versus Percutaneous Transforaminal Endoscopic Discectomy for Treating Lumbar Disc Herniation

10.21203/rs.3.rs-20662/v1 ◽

2020 ◽

Author(s):

Quanyi Li ◽

yongchun zhou

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Intraoperative Blood Loss ◽

Endoscopic Discectomy ◽

Percutaneous Transforaminal Endoscopic Discectomy ◽

Group A ◽

Group B

Abstract Purpose: To compare the efficacy of conventional interlaminar fenestration discectomy (IFD) versus percutaneous transforaminal endoscopic discectomy (PTED) for treating lumbar disc herniation (LDH). Methods: The clinical data of 1,100 patients who had been diagnosed with LDH from January 2012 to December 2017 were retrospectively analysed. IFD was performed on the 605 patients in Group A, while PTED was performed on the 505 patients in Group B. The Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) for pain, and modified Macnab criteria were adopted to evaluate the outcomes. Moreover, the surgery durations, intraoperative blood loss, postoperative off-bed activities, and postoperative lengths of hospital stay for the two groups were observed. Results: The follow-up period ranged from 24 months to 60 months, with an average duration of 43 months. As the excellent and good outcome rate was 93.5% in Group A and 92.6% in Group B, there were no significant differences in efficacy between the two groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest durations and postoperative lengths of hospital stay than did Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B. Conclusions: Although conventional IFD and PTED had similar levels of efficacy in treating LDH, transforaminal endoscopic discectomy exhibited several advantages, such as less trauma, less bleeding, and a shorter length of hospital stay, and it can be considered an ideal surgical option for treating LDH.Save and Continue

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Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

10.21203/rs.3.rs-594596/v1 ◽

2021 ◽

Author(s):

Hai-Chao He ◽

Xiao-qiang LV ◽

Yong-Jin Zhang

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Cauda Equina Syndrome ◽

Lumbar Disc ◽

Cauda Equina ◽

Lumbar Discectomy ◽

Leg Pain ◽

Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

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Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20174703 ◽

2017 ◽

Vol 3 (6) ◽

pp. 1141

Author(s):

Prakash U. Chavan ◽

Mahendra Gudhe ◽

Ashok Munde ◽

Balaji Jadhav

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operating Time ◽

Lumbar Discectomy ◽

Leg Pain ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Single Level ◽

Group I ◽

Endoscopic Lumbar Discectomy

Background: The objective of the study was to compare surgical outcome of micro-discectomy with transforaminal percutaneous endoscopic lumbar discectomy for single level lumbar disc herniation in Indian rural population.Methods: Retrospective comparative study was designed during the period of October 2012 to June 2015, patients in the age group of 22-75 years with unremitting sciatica with/without back pain, and/or a neurological deficit that correlated with appropriate level and side of neural compression as revealed on MRI, with single level lumbar disc herniation who underwent either microdiscectomy or TPELD were included in the study. Patients were assessed on visual analogue scale (VAS) for back and leg pain, modified macnabs criteria, the Oswestry Disability Index (ODI).Results: Group I (MD) included 44 patients and Group II (TPELD) included 20 patients. Significant improvement was seen in claudication symptom post-operatively in both MD and TPELD. Mean operating time was significantly shorter in MD group (1.11 hrs vs. 1.32 hrs; p<0.01). According to modified MacNab's criteria, outcome were excellent (81.8%), good (9.09%) and fair (9.09%) in MD. Similarly, in TPELD, 80%, 15% and 5% patients had excellent, good and fair outcome respectively. In both groups, no one had a poor outcome. Thus, overall success rate was 100% in the study.Conclusions: TPELD and MD have comparable post-operative outcome in most of the efficacy parameters in Indian rural patients undergoing treatment of single level lumbar disc herniation. Additionally, TPELD offers distinct advantages such as performed under local anaesthesia, preservation of structure, lesser post-operative pain and early mobilization and discharge from hospital.

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The effect of paraspinal muscle-splitting microscopic-assisted discectomy versus percutaneous endoscopic lumbar discectomy on patients in the treatment of far-lateral lumbar disc herniation

10.21203/rs.2.24403/v1 ◽

2020 ◽

Author(s):

LEI KONG ◽

Hong Guang Xu

Keyword(s):

Radiation Exposure ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operating Time ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Far Lateral ◽

The Mean ◽

Endoscopic Lumbar Discectomy

Abstract Background Minimally invasive surgery includes percutaneous endoscopic lumbar discectomy and the microscopic tubular technique. This study aimed to compare the two techniques and evaluate the outcome of the procedure. Methods We retrospectively analyzed patients with far-lateral lumbar disc herniation (FLLDH) from June 2015 to October 2018. Twenty-six patients underwent paraspinal muscle-splitting microscopic-assisted discectomy (MD), and 30 underwent percutaneous endoscopic lumbar discectomy (PELD) surgery. Data included the duration of the operation, duration of intraoperative radiation exposure and average hospitalization. Pre- and postoperative pain scores and neurological functions were recorded using visual analogue scale (VAS) score and Oswestry disability index (ODI). Results A total of 56 patients remained in the study over the 12–24 months. The mean operating time was 65.83 ± 16.64 min in the PELD group, the mean duration of radiation exposure was 2.87±1.19 min and average hospitalization was 3.43 days. The mean operating time was 44.96 ± 16.87 min in the MD group, the mean duration of radiation exposure was 0.78±0.32 min and average hospitalization was 4.12 days. All patients in both groups showed significant improvement of VAS and ODI scores after surgery and until final follow-up. Conclusion Both techniques are minimally invasive, effective, and safe for treating far-lateral lumbar disc herniation in selected patients. Compared with the PELD technique, the MD procedure affords a wider field of vision during operation, shorter operation time, fewer postoperative complications, and a shorter learning curve.

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Lumbar disc herniation: Early surgery versus prolonged conservative treatment.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.09.3309 ◽

2020 ◽

Vol 27 (09) ◽

pp. 1784-1789

Author(s):

Urooj Fatimah Siddiqui ◽

Muhammad Faiq Ali ◽

Muhammad Asim Khan Rehmani ◽

Atiq Ahmed Khan ◽

Sheeraz ◽

...

Keyword(s):

Conservative Treatment ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Surgical Intervention ◽

Lumbar Disc ◽

Outcome Variable ◽

P Value ◽

Group A ◽

Group B ◽

Early Surgical Intervention

We seek to compare pain sensation after surgical and conservative treatment in patients having sciatica with lumbar disc herniation in a routine clinical setting. Objectives: To compare the outcome of early surgical intervention versus prolonged conservative treatment in patients with sciatica due to herniated lumbar intervertebral discs. Study Design: Randomized Control Trial. Setting: Department of Neurosurgery, Dow University of Health Sciences, Civil Hospital Karachi. Period: Aug 1, 2017 till May 31, 2018. Material & Methods: Data was prospectively collected from patients after taking a consent. A total of 70 patients, with 35 patients in each Group A (early surgical intervention) and Group B (prolonged conservative treatment) were included. Demographic data was presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. P-value of ≤ 0.05 was taken significant. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Post stratification independent t-test was applied taking p-value of ≤0.05 as significant. Results: Mean age in group A and B was 45.18±7.64 and 42.78±5.87 years respectively. 30 (85.7%) were male and 05 (14.3%) were female in group A. 28 (80%) were male and 07 (20%) were female in group B. Mean pre and post VAS score in group A was (7.18±0.71 and 2.18±0.55) and group B was (7.78±0.34 and 3.26±0.21). Mean pre and post SF36 BP score in group A was (24.18±3.81 and 65.54±6.14) and group B was (34.29±4.91 and 68.21±5.87). Conclusion: Many patients continue to refer conservative treatment of sciatica, despite of pain but given the results of this study, early surgical intervention appears to be superior to medical management for the treatment of Sciatica with respect to patient outcome.

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Outcomes following discectomy for lumbar disc herniation in patients with substantial back pain

Journal of Neurosurgery Spine ◽

10.3171/2020.4.spine191382 ◽

2020 ◽

Vol 33 (5) ◽

pp. 623-626

Author(s):

Simon Thorbjørn Sørensen ◽

Rachid Bech-Azeddine ◽

Søren Fruensgaard ◽

Mikkel Østerheden Andersen ◽

Leah Carreon

Keyword(s):

Back Pain ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Patient Reported Outcomes ◽

Lumbar Disc ◽

Leg Pain ◽

Patient Reported ◽

Vas Scores ◽

The Mean

OBJECTIVEPatients with lumbar disc herniation (LDH) typically present with lower-extremity radiculopathy. However, there are patients who have concomitant substantial back pain (BP) and are considered candidates for fusion. The purpose of this study was to determine if patients with LDH and substantial BP improve with discectomy alone.METHODSThe DaneSpine database was used to identify 2399 patients with LDH and baseline BP visual analog scale (VAS) scores ≥ 50 who underwent a lumbar discectomy at one of 3 facilities between June 2010 and December 2017. Standard demographic and surgical variables and patient-reported outcomes, including BP and leg pain (LP) VAS scores (0–100), Oswestry Disability Index (ODI), and European Quality of Life–5 Dimensions Questionnaire (EQ-5D) at baseline and 12 months postoperatively, were collected.RESULTSA total of 1654 patients (69%) had 12-month data available, with a mean age of 48.7 years; 816 (49%) were male and the mean BMI was 27 kg/m2. At 12 months postoperatively, there were statistically significant improvements (p < 0.0001) in BP (72.6 to 36.9), LP (74.8 to 32.6), ODI (50.9 to 25.1), and EQ-5D (0.25 to 0.65) scores.CONCLUSIONSPatients with LDH and LP and concomitant substantial BP can be counseled to expect improvement in their BP 12 months after surgery after a discectomy alone, as well as improvement in their LP.

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Clinical Effect of Lateral Transforaminal Endoscopic Surgery in the Treatment of Lumbar Disc Herniation

Proceedings of Anticancer Research ◽

10.26689/par.v5i6.2806 ◽

2021 ◽

Vol 5 (6) ◽

pp. 68-72

Author(s):

Weiya Zhang

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Endoscopic Surgery ◽

Early Stage ◽

Lumbar Disc ◽

Normal Function ◽

Significant Difference ◽

Group A ◽

Group B ◽

Transforaminal Endoscopic Surgery

Objective: To analyze the efficacy of lateral transforaminal endoscopic surgery in the treatment of lumbar disc herniation. Methods: A total of 44 patients with lumbar disc herniation, treated in Yancheng No.1 People’s Hospital from January 2019 to June 2020, were randomly divided into two groups; the 24 patients in group A were treated by lateral transforaminal endoscopic surgery, while the 20 patients in group B were treated by routine lamina fenestration and nucleus pulposus surgery. Results: The curative effect of group A (91.67%) was higher than that of group B (85.0%), P > 0.05; there was no significant difference in the angle from straight leg raise between group A and group B (P > 0.05); the Oswestry Disability Index (ODI) and the visual analogue scale (VAS) of group A were lower than those of group B (P < 0.05); the incision length, intraoperative blood loss, and hospital stay of the patients in group A were better than those in group B, P < 0.05. Conclusion: Lateral transforaminal endoscopic surgery can significantly reduce pain, improve symptoms, and help to restore normal function in the early stage for patients with lumbar disc herniation.

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Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated Lumbar Disc Herniation

January 2018 - Pain Physician ◽

10.36076/ppj.2017.1.e75 ◽

2017 ◽

Vol 1 (21;1) ◽

pp. E75-E84 ◽

Cited By ~ 1

Author(s):

Zhong-Liang Deng

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Transforaminal Approach ◽

Interlaminar Approach ◽

Operation Duration ◽

The Mean ◽

Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) has been growing in popularity for the treatment of lumbar disc herniation (LDH) due to its irreplaceable advantages over conventional open surgery. Compared with common lumbar disc herniations, discectomy of highly migrated LDH by PELD is known to be very difficult. Highly migrated lumbar disc herniation has long been a challenge for its specific characteristics. Three approaches for PELD have been applied to access a highly migrated LDH, including an interlaminar approach (IL), transforaminal approach (TF), and contralateral transforaminal approach (CTF). However, none of the existing research has systematically described the selection of the most appropriate procedure from the 3 approaches or the individualization of an operative procedure in different cases. Objectives: The purpose of this study was to present a detailed surgical approach selection and individualization of procedure in the treatment of highly migrated LDH with PELD. We also mean to compare the outcomes of patients with highly migrated LDH treated with PELD by the 3 approaches. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: In our retrospective analysis between March 2011 and March 2013, 73 patients with single level highly migrated LDH received PELD. Clinical outcomes were assessed with the visual analogue scale (VAS) score, the modified MacNab criteria, and the Oswestry disability index (ODI). Relevant data such as operation duration and fluoroscopy frequency of the 3 operative approaches were recorded. Results: The mean operating time of IL was 56 minutes, compared with 64 minutes for TF and 112 minutes for CTF. The mean intraoperative fluoroscopy times were 5.5 for IL, 9.7 for TF, and 14.6 for CTF. In each group, the mean VAS and ODI after surgery and 3 months after surgery improved dramatically compared with preoperative counterparts. However, the difference between postoperative results and the results 3 months after surgery was not significant (P > 0.05). The overall excellent rate was 90.4% according to the modified MacNab criteria; there was no significant statistical difference between the 3 operative routes. Operative complications occurred in 3 patients (2 after IL and one after CTF, 3 of 73, 4.1%). Limitations: This study is limited by its sample size. Conclusion: In our research, PELD with all 3 approaches was similarly effective to highly migrated disc herniation. The CTF approach required the longest operation duration and the most intraoperative times. On the contrary, the least operation time and radiographfrequency was required with the IL approach. In addition, we came to a conclusion of surgery approach selection when it comes to varied HM-LDH. Key words: Highly migrated, lumbar disc herniation, percutaneous endoscopic lumbar discectomy, minimally invasive treatment Pain Physician 2017;

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