Learning Curve for Percutaneous Endoscopic Lumbar Discectomy

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.

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An Amendment to the Neidre and MacNab Classification System for Lumbosacral Nerve Root Anomaly and Its Implication in Percutaneous Endoscopic Lumbar Discectomy

World Neurosurgery ◽

10.1016/j.wneu.2017.12.004 ◽

2018 ◽

Vol 111 ◽

pp. 16-21

Author(s):

Chen Yu ◽

Chang Zhengqi ◽

Yu Xiuchun

Keyword(s):

Nerve Root ◽

Classification System ◽

Lumbar Discectomy ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Endoscopic Lumbar Discectomy

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Risk of reoperation and infection after percutaneous endoscopic lumbar discectomy and open lumbar discectomy

The Bone & Joint Journal ◽

10.1302/0301-620x.103b8.bjj-2020-2541.r2 ◽

2021 ◽

Vol 103-B (8) ◽

pp. 1392-1399

Author(s):

Tae Wook Kang ◽

Si Young Park ◽

Hoonji Oh ◽

Soon Hyuck Lee ◽

Jong Hoon Park ◽

...

Keyword(s):

Lumbar Disc ◽

Surgical Techniques ◽

Lumbar Discectomy ◽

Infection Rates ◽

Percutaneous Endoscopic Lumbar Discectomy ◽

Primary Endpoints ◽

Registration Number ◽

History Of ◽

Endoscopic Lumbar Discectomy ◽

Reoperation Rates

Aims Open discectomy (OD) is the standard operation for lumbar disc herniation (LDH). Percutaneous endoscopic lumbar discectomy (PELD), however, has shown similar outcomes to OD and there is increasing interest in this procedure. However despite improved surgical techniques and instrumentation, reoperation and infection rates continue and are reported to be between 6% and 24% and 0.7% and 16%, respectively. The objective of this study was to compare the rate of reoperation and infection within six months of patients being treated for LDH either by OD or PELD. Methods In this retrospective, nationwide cohort study, the Korean National Health Insurance database from 1 January 2007 to 31 December 2018 was reviewed. Data were extracted for patients who underwent OD or PELD for LDH without a history of having undergone either procedure during the preceding year. Individual patients were followed for six months through their encrypted unique resident registration number. The primary endpoints were rates of reoperation and infection during the follow-up period. Other risk factors for reoperation and infection were also evalulated. Results Out of 549,531 patients, 522,640 had undergone OD (95.11%) and 26,891 patients had undergone PELD (4.89%). Reoperation rates within six months were 2.28% in the OD group, and 5.38% in the PELD group. Infection rates were 1.18% in OD group and 0.83% in PELD group. The risk of reoperation was lower for patients with OD than for patients with PELD (adjusted hazard ratio (HR) 0.38). The risk of infection was higher for patients with OD than for patients undergoing PELD (HR, 1.325). Conclusion Compared with the OD group, the PELD group showed higher reoperation rates and lower infection rates. Cite this article: Bone Joint J 2021;103-B(8):1392–1399.

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