Unilateral biportal endoscopic discectomy versus percutaneous endoscopic lumbar discectomy in the treatment of lumbar disc herniation: a retrospective study

Abstract Background Unilateral biportal endoscopic discectomy (UBE) is a rapidly growing surgical method that uses arthroscopic system for treatment of lumbar disc herniation (LDH), while percutaneous endoscopic lumbar discectomy (PELD) has been standardized as a representative minimally invasive spine surgical technique for LDH. The purpose of this study was to compare the clinical outcomes between UBE and PELD for treatment of patients with LDH. Methods The subjects consisted of 54 patients who underwent UBE (24 cases) and PELD (30 cases) who were followed up for at least 6 months. All patients had lumber disc herniation for 1 level. Outcomes of the patients were assessed with operation time, incision length, hospital stay, total blood loss (TBL), intraoperative blood loss (IBL), hidden blood loss (HBL), complications, total hospitalization costs, visual analogue scale (VAS) for back and leg pain, the Oswestry disability index (ODI) and modified MacNab criteria. Results The VAS scores and ODI decreased significantly in two groups after operation. Preoperative and 1 day, 1 month, 6 months after operation VAS and ODI scores were not significantly different between the two groups. Compared with PELD group, UBE group was associated with higher TBL, higher IBL, higher HBL, longer operation time, longer hospital stay, longer incision length, and more total hospitalization costs. However, a dural tear occurred in one patient of the UBE group. There was no significant difference in the rate of complications between the two groups. Conclusions Application of UBE for treatment of lumbar disc herniation yielded similar clinical outcomes to PELD, including pain control and patient satisfaction. However, UBE was associated with various disadvantages relative to PELD, including increased total, intraoperative and hidden blood loss, longer operation times, longer hospital stays, and more total hospitalization costs.

Download Full-text

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

BMC Surgery ◽

10.1186/s12893-021-01255-7 ◽

2021 ◽

Vol 21 (1) ◽

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 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.

Download Full-text

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.

Download Full-text

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

Download Full-text

Clinical comparison of Unilateral Biportal Endoscopic Discectomy with Percutaneous Endoscopic Lumbar Discectomy for single L4/5 level lumbar disc herniation

Pain Practice ◽

10.1111/papr.13078 ◽

2021 ◽

Author(s):

Jie Hao ◽

Jiaqi Cheng ◽

Huawei Xue ◽

Feng Zhang

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Clinical Comparison ◽

Endoscopic Discectomy ◽

Endoscopic Lumbar Discectomy

Download Full-text

Endoscopic Retrieval of a Broken Guidewire During Spinal Surgery

January 2018 - Pain Physician ◽

10.36076/ppj/2016.19.e339 ◽

2016 ◽

Vol 19 (2;2) ◽

pp. E339-E342 ◽

Cited By ~ 1

Author(s):

Xin Gu

Keyword(s):

Minimally Invasive ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Preoperative Evaluation ◽

Posterolateral Approach ◽

Intraoperative Complication ◽

Endoscopic Discectomy ◽

Endoscopic Retrieval ◽

Endoscopic Lumbar Discectomy

Since the percutaneous posterolateral approach in treating lumbar disc herniation was introduced in 1973, percutaneous endoscopic lumbar discectomy (PELD) has become a routine minimally invasive spinal procedure. However, as clinical evidence accumulated, several complications of PELD have raised our concerns, including the intraoperative injury to neural, vascular structures and failure of surgery. Herein, we present 2 patients who experienced guidewire breakage during PELD procedure to demonstrate the details. The 2 patients, who are 28 and 33 years old, were diagnosed with lumbar disc herniation with or without intervertebral foreman stenosis by magnetic resonance imaging. Following a preoperative evaluation, a PELD procedure was performed with the help of local anesthesia. During the advancement of the obturator and foraminotomy under fluoroscopy, the guidewire was found broken. With the patients’ permission, the operator inserted the working cannula to the broken end of the guidewire and retrieved it by straight grasping forceps under endoscopy. The patients were reported to recover from their back pain immediately after the operation and hence the postoperative course was stable. In conclusion, the guidewire breakage in PELD procedures is a rare but severe complication, which requires immediate removal. An appropriate manner and fluoroscopic control are recommended to forestall such problems. It is possible to retrieve the broken guidewire under endoscopy with skillful experience. Key words: Endoscopic discectomy, intraoperative complication, instrument breakage, minimally invasive surgery

Download Full-text

Biportal endoscopic discectomy for high-grade migrated lumbar disc herniation

Journal of Neurosurgery Spine ◽

10.3171/2020.2.spine191452 ◽

2020 ◽

Vol 33 (3) ◽

pp. 360-365

Author(s):

Taewook Kang ◽

Si Young Park ◽

Gun Woo Park ◽

Soon Hyuck Lee ◽

Jong Hoon Park ◽

...

Keyword(s):

Clinical Outcomes ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Low Grade ◽

High Grade ◽

Grade Group ◽

Significant Difference ◽

Endoscopic Discectomy

OBJECTIVEAlthough endoscopic procedures for lumbar disc herniation have improved greatly and offer many advantages, the indications are limited mostly to nonmigrated or low-grade migrated disc herniation. Endoscopic application in migrated disc herniation cases is still challenging and technically demanding. The goal in this study was to determine the feasibility of biportal endoscopic discectomy for removal of high-grade migrated disc herniation.METHODSA retrospective review was performed in 262 patients who had undergone biportal endoscopic discectomy after the diagnosis of lumbar herniated disc. According to preoperative MRI findings, disc herniation was classified into 5 zones based on the direction and distance from the disc space. Patients were divided into 2 groups—a high-grade migration group and a low-grade migration group. Clinical outcomes were evaluated using the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified Macnab criteria, and those outcomes and operation time were compared between the 2 groups.RESULTSThere were 10 patients with “high-grade up,” 8 with “low-grade up,” 98 with disc-level, 102 with “low-grade down,” and 44 with “high-grade down” herniation, thereby yielding 54 patients in the high-grade group and 208 in the low-grade group. Demographic data for the 2 groups showed no significant difference. There was no significant difference between the 2 groups in ODI, VAS, and modified Macnab criteria. Operation time between the 2 groups was not significantly different (60.74 vs 65.63 minutes, p > 0.05).CONCLUSIONSBiportal endoscopic discectomy can be effective for high-grade migrated lumbar disc herniation with no prolonged operation time and satisfactory clinical outcomes.

Download Full-text

Endoscopic lumbar discectomy using side viewing conical working tube

Romanian Neurosurgery ◽

10.33962/roneuro-2021-018 ◽

2021 ◽

pp. 108-113

Author(s):

Mohammad Kaif ◽

Kuldeep Yadav ◽

Rakesh Kumar ◽

Deepak Kumar Singh

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Long Term Results ◽

Lumbar Disc Prolapse ◽

Endoscopic Discectomy ◽

The Mean ◽

Endoscopic Lumbar Discectomy

Objective: The paradigm of surgical therapy for spinal disease especially for lumbar disc herniation has gradually shifted from traditional open surgeries to minimally invasive spinal surgeries. Endoscopic discectomy has been performed widely using various devices and techniques. In this study, we present our experience of endoscopic discectomy using a unique device with separate side viewing channel. Methods: 26 patients of lumbar disc herniation treated between March 2015 to April 2018 using the unique conical working tube with separate side-viewing endoscopic channel have been retrospectively analysed. Their preoperative and postoperative Oswestry Disability Index (ODI) and Macnab scores were used to evaluate the outcome with a mean follow up of 37.04 months. Results: There were 18 males and 08 females with age ranging from 19-72 years (mean-38.4 years). The follow up ranged from 25 months to 60 months with a mean of 37.04 months. The mean preoperative ODI score was 72.4 which decreased to a mean of 7.6 and the outcome evaluated by Macnab criteria was 65.3% excellent, 19.2 % good, 11.5% fair, 3.8% poor. 1 patient underwent a second surgery. None of the patients had to change their occupation postoperatively. Complications occurred were dural tear in 1 patient and transient foot paresis in 1 which improved spontaneously. Conclusion: Endoscopic discectomy using conical working tube is a safe and effective technique for lumbar disc prolapse. The long term results are comparable to conventional techniques.

Download Full-text

Comparison of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with and without Foraminoplasty for Lumbar Disc Herniation: A 2-Year Follow-Up

Pain Research and Management ◽

10.1155/2019/6924941 ◽

2019 ◽

Vol 2019 ◽

pp. 1-12 ◽

Cited By ~ 1

Author(s):

Binbin Wu ◽

Gonghao Zhan ◽

Xinyi Tian ◽

Linyu Fan ◽

Chenchen Jiang ◽

...

Keyword(s):

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Lumbar Discectomy ◽

Low Back ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Significant Difference ◽

Endoscopic Lumbar Discectomy

Background. Both transforaminal percutaneous endoscopic lumbar discectomy with foraminoplasty (TF PELF) and transforaminal percutaneous endoscopic lumbar discectomy without foraminoplasty (TF PELD) were developed for lumbar disc herniation (LDH) patients. However, the safety and effectiveness between the TF PELF and TF PELD have not been investigated. Methods. Of the included 140 LDH patients, 62 patients received TF PELF (PELF group) and 78 patients received TF PELD (PELD group). The operation time, the duration of staying at the hospital, and complication incidences were recorded. All patients were followed up for 2 years, where low back and leg visual analogue scale (VAS) pain ratings and Oswestry Disability Index (ODI) were compared between the 2 groups before and after surgery. Modified Macnab criterion was estimated for all patients at postoperative 2 years. Results. There were no significant difference of the operation time, number of days staying at the hospital, and the incidence of complications between the 2 groups (P>0.05). Two cases in the PELF group and 1 case in the PELD group received a second surgery due to unrelieved symptoms postoperatively. Low back and leg VAS and ODI scores decreased in both groups after operation (P<0.01), respectively, but were not significant between the 2 groups over time (P>0.05). Six patients in the PELF group and 3 patients in the PELD group did not continue the follow-up; thus, only 131 patients completed Macnab evaluation. The satisfactory rate was reported as 80.4% in the PELF group and 90.7% in the PELD group (P>0.05). Conclusions. This study suggested that the safety and effectiveness of TF PELF are comparable to TF PELD for LDH patients.

Download Full-text