Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

Abstract Background The area which located at the medial pedicle, posterior vertebral body and ventral hemilamina is defined as the hidden zone. Surgical management of hidden zone lumbar disc herniation (HZLDH) is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce microscopic extra-laminar sequestrectomy (MELS) technique for treatment of hidden zone lumbar disc herniation and present clinical outcomes. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with HZLDH were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and fragment were visually exposed using MELS. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 (18–24) months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is safe and effective in the management of HZLDH. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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Microscopic extra-laminar sequestrectomy (MELS) for the treatment of hidden zone lumbar disc herniation: report of the surgical technique, patient selection, and clinical outcomes

10.21203/rs.3.rs-37318/v1 ◽

2020 ◽

Author(s):

Chunxiao Wang ◽

Yao Zhang ◽

Xiaojie Tang ◽

Haifei Cao ◽

Qinyong Song ◽

...

Keyword(s):

Blood Loss ◽

Learning Curve ◽

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Operation Duration ◽

The Mean

Abstract Background Surgical management of lumbar disc herniation in the hidden zone is technically challenging due to its difficult surgical exposure. The conventional interlaminar approach harbors the potential risk of post-surgical instability, while other approaches consist of complicated procedures with a steep learning curve and prolonged operation time. Objective To introduce a safe and effective technique named microscopic extra-laminar sequestrectomy (MELS) for treatment of hidden zone lumbar disc herniation and present clinical outcomes within a two year follow-up period. Methods Between Jan 2016 to Jan 2018, twenty one patients (13 males) with hidden zone lumbar disc herniation were enrolled in this study. All patients underwent MELS (19 patients underwent sequestrectomy only, 2 patients underwent an additional inferior discectomy). The nerve root and herniated fragment were visually exposed using this extra-laminar approach. The operation duration, blood loss, intra- and postoperative complications, and recurrences were recorded. The Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and the modified MacNab criteria were used to evaluate clinical outcomes. Postoperative stability was evaluated both radiologically and clinically. Results The mean follow-up period was 20.95 ± 2.09 months, ranging from 18 to 24 months. The mean operation time was 32.43 ± 7.19 min and the mean blood loss was 25.52 ± 5.37 ml. All patients showed complete neurological symptom relief after surgery. The VAS and ODI score were significantly improved at the final follow-up compared to those before operation (7.88 ± 0.70 vs 0.10 ± 0.30, 59.24 ± 10.83 vs 11.29 ± 3.59, respectively, p < 0.05). Seventeen patients (81%) obtained an “excellent” outcome and the remaining four (19%) patients obtained a “good” outcome based the MacNab criteria. One patient suffered reherniation at the same level one year after the initial surgery and underwent a transforaminal endoscopic discectomy. No major complications and postoperative instability were observed. Conclusions Our observation suggest that MELS is a safe and effective method in the management of hidden zone lumbar disc herniation. Due to its relative simplicity, it comprises a flat surgical learning curve and shorter operation duration, and overall results in reduced disturbance to lumbar stability.

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Minimally invasive lumbar microdiscectomy in pediatric patients: a series of 6 patients

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.3.peds10570 ◽

2011 ◽

Vol 7 (6) ◽

pp. 616-619 ◽

Cited By ~ 4

Author(s):

Jonathan G. Thomas ◽

Steven W. Hwang ◽

William E. Whitehead ◽

Daniel J. Curry ◽

Thomas G. Luerssen ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Presenting Symptoms ◽

Lumbar Microdiscectomy ◽

Imaging Results ◽

The Mean

Object Lumbar disc herniation is rare in the pediatric age group, but may still cause a significant amount of pain and disability. Whereas minimally invasive surgery (MIS) for lumbar disc herniation is routinely performed in adults, it has not yet been described in the pediatric population. The purpose of this study was to describe the surgical results of pediatric MIS-treated lumbar disc disease. Methods The authors retrospectively reviewed a series of 6 consecutive cases of lumbar microdiscectomy performed using MIS techniques between April 2008 and July 2010. Presenting symptoms, physical examination findings, and preoperative MR imaging results were obtained from medical records. Perioperative results, including blood loss, length of hospital stay, and complications were assessed. Findings at latest follow-up evaluation were also recorded. Results This report represents the first surgical series regarding pediatric lumbar microdiscectomies performed using MIS. The mean patient age was 16 years (range 14–17 years); there were 4 girls and 2 boys. Preoperative signs and symptoms of radiculopathic pain were notable in 100% of patients, and myotomal weakness was noted in 33% of patients. The first line of treatment in all patients was a period of conservative management lasting an average of 11.5 months (range 6–12 months). The mean intraoperative blood loss was 10.8 ml, and the mean postoperative length of stay was 1.3 days. There were no complications in this small series. Conclusions The treatment of pediatric lumbar disc herniation by using MIS techniques can be safe and efficacious. However, further study with a larger number of patients and longer follow-up is needed to compare outcomes between MIS and open microdiscectomies.

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Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Neurosurgical FOCUS ◽

10.3171/2015.10.focus15484 ◽

2016 ◽

Vol 40 (2) ◽

pp. E3 ◽

Cited By ~ 39

Author(s):

Pravesh S. Gadjradj ◽

Maurits W. van Tulder ◽

Clemens M. F. Dirven ◽

Wilco C. Peul ◽

B. Sanjay Harhangi

Keyword(s):

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Case Series ◽

Endoscopic Discectomy ◽

Duration Of Surgery ◽

Percutaneous Transforaminal Endoscopic Discectomy ◽

The Mean

OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed. The primary outcomes were the visual analog scale (VAS) score for leg pain and the score on the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes were the perceived experience with the local anesthesia used and satisfaction with the results after 1 year using Likert-type scales. The pretreatment means were compared with the means obtained 6 and 52 weeks after surgery using paired t-tests. RESULTS A total of 166 patients underwent surgery for a total of 167 LDHs. The mean duration of surgery (± SD) was 51.0 ± 9.0 minutes. The 1-year follow-up rate was 95.2%. The mean reported scores on the VAS and QBPDS were 82.5 ± 17.3 mm and 60.0 ± 18.4 at baseline, respectively. Six weeks after surgery, the scores on the VAS and QBPDS were significantly reduced to 28.8 ± 24.5 mm and 26.7 ± 20.6, respectively (p < 0.001). After 52 weeks of follow-up, the scores were further reduced compared with baseline scores (p < 0.001) to 19.6 ± 23.5 mm on the VAS and 20.2 ± 18.1 on the QBPDS. A total of 4 complications were observed, namely 1 dural tear, 1 deficit of ankle dorsiflexion, and 2 cases of transient paresis in the foot due to the use of local anesthetics. CONCLUSIONS PTED appears to be a safe and effective intervention for LDH and has similar clinical outcomes compared to conventional open microdiscectomy. High-quality randomized controlled trials are required to study the efficacy and cost-effectiveness of PTED.

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Tubular approach to minimally invasive microdiscectomy for pediatric lumbar disc herniation

Journal of Neurosurgery Pediatrics ◽

10.3171/2017.11.peds17293 ◽

2018 ◽

Vol 21 (5) ◽

pp. 449-455 ◽

Cited By ~ 3

Author(s):

Julio D. Montejo ◽

Joaquin Q. Camara-Quintana ◽

Daniel Duran ◽

Jeannine M. Rockefeller ◽

Sierra B. Conine ◽

...

Keyword(s):

Minimally Invasive ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Pediatric Patients ◽

Lumbar Disc ◽

Low Back ◽

Duration Of Symptoms ◽

Patient Reported ◽

The Mean

OBJECTIVELumbar disc herniation (LDH) in the pediatric population is rare and exhibits unique characteristics compared with adult LDH. There are limited data regarding the safety and efficacy of minimally invasive surgery (MIS) using tubular retractors in pediatric patients with LDH. Here, the outcomes of MIS tubular microdiscectomy for the treatment of pediatric LDH are evaluated.METHODSTwelve consecutive pediatric patients with LDH were treated with MIS tubular microdiscectomy at the authors’ institution between July 2011 and October 2015. Data were gathered from retrospective chart review and from mail or electronic questionnaires. The Macnab criteria and the Oswestry Disability Index (ODI) were used for outcome measurements.RESULTSThe mean age at surgery was 17 ± 1.6 years (range 13–19 years). Seven patients were female (58%). Prior to surgical intervention, 100% of patients underwent conservative treatment, and 50% had epidural steroid injections. Preoperative low-back and leg pain, positive straight leg raise, and myotomal leg weakness were noted in 100%, 83%, and 67% of patients, respectively. The median duration of symptoms prior to surgery was 9 months (range 1–36 months). The LDH level was L5–S1 in 75% of patients and L4–5 in 25%. The mean ± SD operative time was 90 ± 21 minutes, the estimated blood loss was ≤ 25 ml in 92% of patients (maximum 50 ml), and no intraoperative or postoperative complications were noted at 30 days. The median hospital length of stay was 1 day (range 0–3 days). The median follow-up duration was 2.2 years (range 0–5.8 years). One patient experienced reherniation at 18 months after the initial operation and required a second same-level MIS tubular microdiscectomy to achieve resolution of symptoms. Of the 11 patients seen for follow-up, 10 patients (91%) reported excellent or good satisfaction according to the Macnab criteria at the last follow-up. Only 1 patient reported a fair level of satisfaction by using the same criteria. Seven patients completed an ODI evaluation at the last follow-up. For these 7 patients, the mean ODI low-back pain score was 19.7% (SEM 2.8%).CONCLUSIONSTo the authors’ knowledge, this is the longest outcomes study and the largest series of pediatric patients with LDH who were treated with MIS microdiscectomy using tubular retractors. These data suggest that MIS tubular microdiscectomy is safe and efficacious for pediatric LDH. Larger prospective cohort studies with longer follow-up are needed to better evaluate the long-term efficacy of MIS tubular microdiscectomy versus other open and MIS techniques for the treatment of pediatric LDH.

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Endoscopic Epidural Laser Decompression Versus Transforaminal Epiduroscopic Laser Annuloplasty for Lumbar Disc Herniation: A Prospective, Randomized Trial

January 2018 - Pain Physician ◽

10.36076/ppj/2017.7.633 ◽

2017 ◽

Vol 7 (20;7) ◽

pp. 633-670

Author(s):

Chang Hong Park

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Radicular Pain ◽

Secondary Outcome ◽

Pain Scores ◽

Number Of Patients ◽

The Mean ◽

Lumbar Radicular Pain

Background: Lumbar radicular pain often results from lumbar disc herniation, spinal stenosis, or degenerative spondylolisthesis. Minimally invasive disc decompression procedures, such as nucleoannuloplasty or epiduroscopic neural decompression by laser, have been devised to treat such pain. Objective: The short-term outcomes of disc decompression by endoscopic epidural laser decompression (EELD) or transforaminal epiduroscopic laser annuloplasty (TELA) were compared in patients with lumbar radicular pain due to disc herniation. Study Design: A randomized, prospective trial. Setting: The Department of Anesthesiology and Pain Medicine at Spine Health Wooridul Hospital in Daegu, Korea. Methods: A total of 97 patients were enrolled in this study; 48 patients underwent EELD and 49 underwent TELA. The pain relief was evaluated at baseline and at 1, 3, and 6 months post-procedure via the numeric rating scale (NRS). The Oswestry Disability Index (ODI) was recorded at baseline and at the final follow-up. Postoperative wound pain was assessed over a 24-hour period. Complications and side effects were also recorded, as were operative times (from local anesthetic infiltration at entry sites to suturing of skin). Results: At post-treatment months 1, 3, and 6 the mean pain scores of patients were significantly lower (relative to pre-treatment baseline) regardless of the procedure used. However, the mean pain scores did not differ significantly by procedure (EELD vs TELA). As well, the number of patients who obtained relief from their pain and needed analgesics was not statistically significant. The irrigation volume was significantly higher in the TELA group. Two patients undergoing TELA procedures experienced headache during the procedures; however, no serious complications such as bleeding, dural/neural injuries, or infection were recorded for either group. Limitation: The observed significant reductions in pain (from baseline) lacked secondary outcome substantiation and given the mid follow-up period, no long-term follow-up results were monitored. Conclusion: Both EELD and TELA provide similar outcomes and are reasonable treatment options for carefully selected patients with lower back or radicular pain. Key words: Epiduroscopy, laser, annuloplasty, disc, herniation, TELA

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Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

10.21203/rs.3.rs-35673/v1 ◽

2020 ◽

Author(s):

Seong Son ◽

Chan Jong Yoo ◽

Byung Rhae Yoo ◽

Woo Seok Kim ◽

Tae Seok Jeong

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Learning Curve ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Early Group ◽

Significant Difference ◽

Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

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Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

10.21203/rs.3.rs-35673/v3 ◽

2020 ◽

Author(s):

Seong Son ◽

Chan Jong Yoo ◽

Byung Rhae Yoo ◽

Woo Seok Kim ◽

Tae Seok Jeong

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Learning Curve ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Early Group ◽

Significant Difference ◽

Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation.However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

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15-year survivorship analysis of an interspinous device in surgery for single-level lumbar disc herniation

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04929-8 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yoon Joo Cho ◽

Jong-Beom Park ◽

Dong-Gune Chang ◽

Hong Jin Kim

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Reoperation Rate ◽

Rank Test ◽

Intermediate Step ◽

Survivorship Analysis ◽

Interspinous Device ◽

The Mean

Abstract Background Interspinous devices have been introduced as alternatives to decompression or fusion in surgery for degenerative lumbar diseases. This study aimed to investigate 15-year survivorship and risk factors for reoperation of a Device for Intervertebral Assisted Motion (DIAM) in surgery for 1-level lumbar disc herniation (LDH). Methods A total of 94 patients (54 men and 40 women) underwent discectomy and DIAM implantation for 1-level LDH, with a mean follow-up of 12.9 years (range, 6.3–15.3 years). The mean age was 46.2 years (range, 21–65 years). Sixty-two patients underwent DIAM implantation for L4–5, 27 for L5–6, and 5 for L3–4. Reoperations due to any reason associated with DIAM implantation level or adjacent levels were defined as failure and used as the end point of determining survivorship. Results During the 15-year follow-up, 8 patients (4 men and 4 women) underwent reoperation due to recurrence of LDH at the DIAM implantation level, a reoperation rate of 8.5%. The mean time to reoperation was 6.5 years (range, 0.8–13.9 years). Kaplan-Meier analysis showed a cumulative survival rate of the DIAM implantation of 97% at 5 years, 93% at 10 years, and 92% at 15 years after surgery; the cumulative reoperation rate of the DIAM implantation was 3% at 5 years, 7% at 10 years, and 8% at 15 years after surgery. Mean survival time was predicted to be 14.5 years (95% CI, 13.97–15.07). The log-rank test and Cox proportional hazard model showed that age, sex, and location did not significantly affect the reoperation rate of DIAM implantation. Conclusions Our results showed that DIAM implantation significantly decreased reoperation rate for LDH in the 15-year survivorship analysis. We suggest that DIAM implantation could be considered a useful intermediate step procedure for LDH surgery. To the best of our knowledge, this is the longest follow-up study in which surgical outcomes of interspinous device surgery were reported.

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Clinical Evaluation, Functional Outcome and Complications of MicroEndoscopic Discectomy(MED) in Single or Double Level Lumbar Disc Herniation- A Retrospective Review of 156 Patients

10.13107/bbj.2021.v02i01.012 ◽

2021 ◽

Vol 2 (1) ◽

Keyword(s):

Clinical Outcome ◽

Hospital Stay ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Activity Level ◽

Estimated Blood Loss ◽

Microendoscopic Discectomy

Introduction: Lumbar disc herniation (LDH) is one of the most common causes for low back pain and related disabilities. Surgery is indicated in patients who do not respond to the conservative measures for at least 6 weeks or symptoms are worsened. Microendoscopic discectomy (MED) is a well-accepted minimally invasive surgical technique with similar results compared to open surgery. The purpose of this study was to evaluate the clinical outcome, functional improvement and analyze complications during MED. Methods: A retrospective analysis was conducted in 156 patients who were operated for single or double level LDH using MED between 2016 and 2018. All patients were evaluated for pain and disability using visual analogue scale (VAS) and Oswestry disability index (ODI), respectively. Modified MabNab’s criteria used to evaluate overall outcome of surgery. Operation time, estimated blood loss (EBL), hospital stay and time to return back to previous activities were evaluated. Complications and revisions were noted during follow-up to analyze clinical results. Paired t-test was used to evaluate statistical difference in VAS and ODI score during follow-up. Results: All patients were followed up at 6 weeks, 3 months, 6 months, 1 year and yearly thereafter postoperatively. Average follow-up was 25.5±9.7 months and average age was 45.0±12.7 years. Average VAS scores improved significantly from preoperative 8.7±0.8 to 2.0±1.1 postoperatively (p<0.0001). Average preoperative ODI improved significantly from 53.8±6.1 to 22.6±5.1 postoperatively (p<0.0001). Both score were maintained at the final follow-up. The average time to return to previous activity level was 35.7±14.3 days. Average operation time, EBL and hospital stay were 57.6±14.6 minutes, 36.7±13.1 mL and 2.4±0.7 days, respectively. There were total 19 (12.2%) complications and 12 (7.7%) revisions in the series. Overall clinical outcome was excellent, good, fair and poor in 73.1%, 20.5%, 5.1% and 1.3% of cases using modi

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Minimum of Two-Year Follow-up After Percutaneous Endoscopic Transforaminal Discectomy on Lumbar Disc Herniation: Clinical and Radiographic Outcomes

10.21203/rs.3.rs-1050709/v1 ◽

2021 ◽

Author(s):

Lei Yue ◽

Hao Chen ◽

Guanzhang Mu ◽

Bingxu Li ◽

Haoyong Fu ◽

...

Keyword(s):

Factor Analysis ◽

Risk Factor ◽

Intervertebral Disc ◽

Clinical Outcomes ◽

Disc Degeneration ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc

Abstract Background Percutaneous endoscopic transforaminal discectomy (PETD) is a widely-used minimally invasive technique in treating lumbar disc herniation (LDH), our aim was to investigate the long-term effect of PETD on clinical outcomes and magnetic resonance imaging (MRI) characteristics of LDH patients.Methods This is a retrospective case series to assess patients who underwent single level PETD from January 2015 to June 2019 with a minimum follow-up of 2 years. Clinical outcomes included numeric rating scale (NRS), Oswestry Disability Index (ODI) and adverse events. Radiographic parameters included sagittal spine geometry, characteristics of protrusion, and degeneration grading of intervertebral disc and facet joint. Sensitivity analysis and risk factor analysis were also performed.Results Thirty-eight patients (43.16 ± 13.32 years; M: F = 20: 18) were assessed. During the follow-up period (33.47±12.53 months), the mean disc height decreased from 10.27 ± 1.92 mm to 8.95 ± 1.74 mm (P=0.000), and lumbar lordosis increased from 31.31 ± 8.63° to 35.07 ± 8.07° (P=0.002). The size of protrusion significantly decreased after PETD (P=0.000). Disc degeneration grading was generally higher at last follow-up compared with baseline (p=0.002). Compared with baseline, significant improvements were observed on NRS and ODI at 3-months follow-up and the last follow-up. On risk factor analysis, facet tropism was correlated with radiographic recurrence of disc herniation (OR=6.00 [95% confidential interval (CI)1.176-30.624], p=0.031).Conclusions This study demonstrates that at long-term follow-up, despite the good clinical results, the PETD resulted in significant aggravation of intervertebral disc degeneration.

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