AN ANESTHESIA SUGGESTION FOR ENDOSCOPIC LUMBAR SPINE SURGERY

2021 ◽  
Vol 20 (4) ◽  
pp. 305-306
Author(s):  
João Abrão ◽  
Herton Rodrigo Tavares Costa ◽  
Alexandre Cubas da Silva ◽  
Edgar Takao Utino ◽  
João Paulo Bergamaschi
Keyword(s):  
World Literature ◽  
Conscious Sedation ◽  
Bone Structure ◽  
Lumbar Discectomy ◽  
Lumbar Spine Surgery ◽  
Outpatient Basis ◽  
Level Of Evidence ◽  
Obstetric Analgesia ◽  
Endoscopic Lumbar Discectomy

ABSTRACT Percutaneous endoscopic lumbar discectomy causes less damage to the paravertebral musculature, with preservation of bone structure and rapid recovery. This innovation allows the surgery to be performed on an outpatient basis, due to the faster recovery time. The anesthesia traditionally performed was general anesthesia, and then conscious sedation. The prone position has always been a major challenge for anesthesiologists. In order to avoid any type of respiratory depression, and based on our own experience with obstetric analgesia, we propose to perform an analgesic spinal anesthesia, a technique not yet found for this type of surgery in the world literature. Level of evidence I; Quality of Evidence A

scholarly journals Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Hua Li ◽  
Yufu Ou ◽  
Furong Xie ◽  
Weiguo Liang ◽  
Gang Tian ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Discectomy ◽  
Lumbar Spine Surgery ◽  
Decompression Surgery ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Pain Scores ◽  
Endoscopic Lumbar Discectomy ◽  
Lumbar Spinal

Abstract Background Although percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (ages 65–74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P < 0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P > 0.05). Conclusion PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

scholarly journals Long-term Follow-up Results of Percutaneous Endoscopic Lumbar Discectomy

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. E1161-E1166
Author(s):  
Luigi Andrew Sabal
Keyword(s):  
Lumbar Discectomy ◽  
Disc Height ◽  
Lumbar Spine Surgery ◽  
Long Term Outcomes ◽  
Height Ratio ◽  
Radiographic Findings ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy

Background: Open lumbar microdiscectomy (OLM) has been considered the gold standard in the management of lumbar disc herniation (LDH) for its favorable outcomes in longterm follow-up. Nowadays, percutaneous endoscopic lumbar discectomy (PELD) is gaining recognition. However, greatest limitation of studies of PELD is the lack of long-term followup outcomes. Objective: To investigate the long-term outcomes of PELD in terms of clinical and radiographic findings and revision surgery rate. Study Design: Retrospective study. Setting: Spine hospital. Methods: Sixty-two patients who underwent PELD 10 years previously were contacted for follow-up. Clinical parameters such as the visual analog scale scores for the back and legs (VAS-B and VAS-L, respectively), the Oswestry disability index (ODI), and radiographic findings such as the disc-height ratio and change in the difference between flexion and extension were recorded and compared to the preoperative values. Results: For 62 followed patients, 38 met our inclusion criteria (35 transforaminal, 3 interlaminar). Excluded were 6 patients (9.4%) who underwent revision OLM at same level and 17 patients (26.6%) who underwent lumbar spine surgery at other levels. The average followup period was 11.22 (± 0.83) years. For the remaining 38 patients who had no further surgery, the postoperative VAS-B (2.53 ± 1.98), VAS-L (1.82 ± 1.92), and ODI (12.69 ± 11.26) were significantly different from the pre-operative values (8.45 ± 1.52, 7.40 ± 3.04, and 55.33 ± 24.63, respectively; all P = 0.01). The average disc-height ratio was 81.54% of the original disc height. There was no evidence of instability after long-term postoperative follow-up. Limitation: Retrospective nature of data collection. Conclusion: PELD has favorable long-term outcomes. Key words: Long-term, PELD, endoscopic lumbar discectomy, revision rate, disc height, instability

scholarly journals Linical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients: a retrospective study

2020 ◽  
Author(s):  
hua Li ◽  
Yufu Ou ◽  
Furong Xie ◽  
Weiguo Liang ◽  
Gang Tian ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Lumbar Discectomy ◽  
Lumbar Spine Surgery ◽  
Decompression Surgery ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Pain Scores ◽  
Endoscopic Lumbar Discectomy ◽  
Lumbar Spinal

Abstract Background: Although: percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods: In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (age 65-74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results: All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores for pain while performing daily activities were significantly improved in both treatment groups (P<0.05). No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups. Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P>0.05). Conclusion: PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery. Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

scholarly journals Clinical Efficacy of Percutaneous Endoscopic Lumbar Discectomy for the Treatment of Lumbar Spinal Stenosis in Elderly Patients

2020 ◽  
Author(s):  
hua Li ◽  
Yufu Ou ◽  
Furong Xie ◽  
Weiguo Liang ◽  
Gang Tian ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Clinical Efficacy ◽  
Lumbar Discectomy ◽  
Lumbar Spine Surgery ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Pain Scores ◽  
Endoscopic Lumbar Discectomy ◽  
Lumbar Spinal

Abstract Background: Although: percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSSin elderly patients aged 65 years or older. Methods: In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (age 65-74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results: All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P<0.05).No statistically significant between-group differences were observed in operation time, intraoperative blood loss, postoperative bed rest, and postoperative hospital stay (P > 0.05). The overall postoperative complication rate was similar between the two groups.Moreover, no statistically significant differences in VAS-back pain scores, VAS-leg pain scores, JOA scores, and MacNab classification were found between the groups at the 3-month and 1.5-year follow-up examinations (P>0.05).Conclusion: PELD is safe and effective for the treatment of LSS in elderly patients. Age is not a contraindication for decompressive lumbar spine surgery. PELD has advantages such as reduced trauma, fewer anesthesia-related complications, and a fast postoperative recovery.Elderly patients should be considered good candidates for lumbar decompression surgery using minimally invasive techniques.

PEID (Percutaneous Endoscopic Interlaminar Discectomy): Cautionary Points Based on the Evidence

2018 ◽  
Vol 1 (2) ◽  
pp. 7
Author(s):  
Jun Ho Lee
Keyword(s):  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Radiographic Evaluation ◽  
Operative Indication ◽  
Endoscopic Techniques ◽  
Bone Removal ◽  
Iatrogenic Trauma ◽  
Minimal Damage ◽  
Surgical Modality ◽  
Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) is one of the most sophisticated operative procedures for the treatment of lumbar disc herniation (LDH). Endoscopic techniques are now becoming standard in many areas due to expanded technical possibilities of full-endoscopic transforaminal or interlaminar resection of herniated lumbar discs as well as stenosis. However conventional percutaneous endoscopic interlaminar discectomy (PEID) disc operations may sometimes result in subsequent untoward complications due to unnoticed iatrogenic trauma to neural structures, which is mostly related to an anatomical limitation during endoscope insertion.Methods: An appropriate operative indication of the PEID without bone removal or laminectomy can be used to treat LDH cases with an enough interlaminar space (at least ≥ 20 mm by bi-facetal distance) from the reported evidences. Otherwise, there might be several indications for requirement of bone removal; a narrow interlaminar space, disappearance of the concave shape of the upper vertebral laminae, high-grade migration of LDH, recurrent LDH, obesity, or an immobile nerve root.Conclusion: The significance of PEID lies also in its minimal damage to surrounding structures such as muscle, bone, and ligaments. A discrete radiographic evaluation from the patient preoperatively is mandatory before choosing a proper endoscopic surgical modality for the sake of optimal clinical outcome after PEID. 

scholarly journals Developing an evidence assessment framework and appraising the academic literature on migrant health in Malaysia: a scoping review

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041379
Author(s):  
Allard Willem de Smalen ◽  
Zhie X Chan ◽  
Claudia Abreu Lopes ◽  
Michaella Vanore ◽  
Tharani Loganathan ◽  
...  
Keyword(s):  
Scoping Review ◽  
Multiple Correspondence Analysis ◽  
Population Data ◽  
Good Health ◽  
Migrant Health ◽  
High Quality ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
Academic Literature

BackgroundA large number of international migrants in Malaysia face challenges in obtaining good health, the extent of which is still relatively unknown. This study aims to map the existing academic literature on migrant health in Malaysia and to provide an overview of the topical coverage, quality and level of evidence of these scientific studies.MethodsA scoping review was conducted using six databases, including Econlit, Embase, Global Health, Medline, PsycINFO and Social Policy and Practice. Studies were eligible for inclusion if they were conducted in Malaysia, peer-reviewed, focused on a health dimension according to the Bay Area Regional Health Inequities Initiative (BARHII) framework, and targeted the vulnerable international migrant population. Data were extracted by using the BARHII framework and a newly developed decision tree to identify the type of study design and corresponding level of evidence. Modified Joanna Briggs Institute checklists were used to assess study quality, and a multiple-correspondence analysis (MCA) was conducted to identify associations between different variables.Results67 publications met the selection criteria and were included in the study. The majority (n=41) of studies included foreign workers. Over two-thirds (n=46) focused on disease and injury, and a similar number (n=46) had descriptive designs. The average quality of the papers was low, yet quality differed significantly among them. The MCA showed that high-quality studies were mostly qualitative designs that included refugees and focused on living conditions, while prevalence and analytical cross-sectional studies were mostly of low quality.ConclusionThis study provides an overview of the scientific literature on migrant health in Malaysia published between 1965 and 2019. In general, the quality of these studies is low, and various health dimensions have not been thoroughly researched. Therefore, researchers should address these issues to improve the evidence base to support policy-makers with high-quality evidence for decision-making.

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