scholarly journals Does the microendoscopic technique reduce mortality and major complications in patients undergoing lumbar discectomy? A propensity score–matched analysis using a nationwide administrative database

2016 ◽  
Vol 40 (2) ◽  
pp. E5 ◽  
Author(s):  
Junichi Ohya ◽  
Yasushi Oshima ◽  
Hirotaka Chikuda ◽  
Takeshi Oichi ◽  
Hiroki Matsui ◽  
...  
Keyword(s):  
Propensity Score ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Spinal Surgery ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Volume Number ◽  
Minimally Invasive Spinal Surgery ◽  
Major Complications ◽  
Significant Difference

OBJECTIVE Although minimally invasive spinal surgery has recently gained popularity, few nationwide studies have compared the adverse events that occur during endoscopic versus open spinal surgery. The purpose of this study was to compare perioperative complications associated with microendoscopic discectomy (MED) and open discectomy for patients with lumbar disc herniation. METHODS The authors retrospectively extracted from the Diagnosis Procedure Combination database, a national inpatient database in Japan, data for patients admitted between July 2010 and March 2013. Patients who underwent lumbar discectomy without fusion surgery were included in the analysis, and those with an urgent admission were excluded. The authors examined patient age, sex, Charlson Comorbidity Index, body mass index, smoking status, blood transfusion, duration of anesthesia, type of hospital, and hospital volume (number of patients undergoing discectomy at each hospital). One-to-one propensity score matching between the MED and open discectomy groups was performed to compare the proportions of in-hospital deaths, surgical site infections (SSIs), and major complications, including stroke, acute coronary events, pulmonary embolism, respiratory complications, urinary tract infection, and sepsis. The authors also compared the hospital length of stay between the 2 groups. RESULTS A total of 26,612 patients were identified in the database. The mean age was 49.6 years (SD 17.7 years). Among all patients, 17,406 (65.4%) were male and 6422 (24.1%) underwent MED. A propensity score–matched analysis with 6040 pairs of patients showed significant decreases in the occurrence of major complications (0.8% vs 1.3%, p = 0.01) and SSI (0.1% vs 0.2%, p = 0.02) in patients treated with MED compared with those who underwent open discectomy. Overall, MED was associated with significantly lower risks of major complications (OR 0.62, 95% CI 0.43–0.89, p = 0.01) and SSI (OR 0.29, 95% CI 0.09–0.87, p = 0.03) than open discectomy. There was a significant difference in length of hospital stay (11 vs 15 days, p < 0.001) between the groups. There was no significant difference in in-hospital mortality between MED and open discectomy. CONCLUSIONS The microendoscopic technique was associated with lower risks for SSI and major complications following discectomy in patients with lumbar disc herniation.

scholarly journals Endoscopic transforaminal lumbar discectomy in the treatment of multilevel disc herniations

2019 ◽  
Author(s):  
Denglu Yan ◽  
Zaiheng Zhang ◽  
Zhi Zhang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Cerebrospinal Fluid Leakage ◽  
Multiple Level ◽  
Endoscopic Procedures ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
Disc Herniations

Abstract Background There were no studies in literature of multiple level lumbar disc herniation treatment by endoscopic procedures. The purpose of this study was to evaluate the efficacy of endoscopic treatment multiple level lumbar disc herniation by compare to the one level disc herniation. Methods A total of 267 patients of lumbar disc herniation who had endoscopic surgery were categorized into three different groups depending on the level number of endoscopic procedures. 78 cases had one level procedure (OL group), 54 cases had couple level procedures (CL group), and 35 cases had triple level procedures (TL group). Endoscopic discectomy procedures was performed and the clinical outcomes were recorded. Results There was no intraoperative death in this series. The hospital day were no significant difference among three groups. The operational time and blood loss were biggest in triple levels procedures and lest in one level procedure. When take into the influence the numbers of disc herniation, there were no significant difference per level among three groups. The pain index and ODI score were better than preoperational in all patients, and there were no significant difference among three groups. The disk and foramen height, and lumbar lordosis were no significant difference compare to preoperative in all patients, and there were no significant difference among three groups. All patients achieved pain free accomplished all surgery procedures, no infection, and no dural tear of cerebrospinal fluid leakage complication. Conclusions Endoscopic lumbar discectomy was effective and safe procedures in the treatment of multilevel lumbar disc herniation.

scholarly journals The Clinical Results of Percutaneous Endoscopic Interlaminar Discectomy (PEID) in the Treatment of Calcified Lumbar Disc Herniation: A Case-Control Study

2016 ◽  
Vol 19 (2;2) ◽  
pp. 69-75
Author(s):  
Fu Qiang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Case Control Study ◽  
Lumbar Disc ◽  
Case Control ◽  
Lumbar Discectomy ◽  
Herniated Disc ◽  
Significant Difference ◽  
Endoscopic Lumbar Discectomy ◽  
Control Study

Background: Percutaneous endoscopic interlaminar discectomy (PEID), which poses advantages for certain types of herniated disc, is gaining wider acceptance in clinical practice. We retrospectively analyzed the efficacy of the PEID technique in treatment of calcified lumbar disc herniation. Study Design: A retrospective case-control study. Setting: University hospital in China. Objective: To evaluate the efficacy of the PEID technique in treatment of calcified lumbar disc herniation, and a comparison between calcified and noncalcified disc herniation was drawn to analyze the causes of herniated disc calcification. Methods: Data from patients who underwent full-endoscopic lumbar discectomy in our department between March 2011 and May 2013 were collected. Thirty cases with calcified lumbar disc herniation were included in the study group, and 30 age-, gender-, and body mass index (BMI)-matched cases with noncalcified lumbar disc herniation served as controls. Perioperative data, preoperative and postoperative Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) values, MacNab scores, and postoperative low-extremity dysesthesia among patients in the 2 groups were collected. Results: The values of computed tomography (CT) in the calcified group were significantly higher than those in the noncalcified group (P < 0.01). The preoperative disease courses in the 2 groups were similar. However, there was a statistically significant difference in the duration of traditional Chinese medicines (TCM) administration (P < 0.01). VAS and ODI scores improved significantly after surgery, but there were no significant differences between the 2 groups (P > 0.05). Three months after surgery, the rate of low-extremity dysesthesia in the calcified group was significantly higher than that in the control group (P = 0.03) but became similar at 6 months. By applying MacNab criteria the proportions of good and excellent were greater than 90% in both groups, and there was no difference between groups (P > 0.05). Limitations: The sample size was small in this retrospective study. Conclusion: The PEID technique is an effective method in the treatment of calcified lumber disc herniation, although the rate of postoperative dysesthesia is higher in this group during the early postoperative period. Long-term TCM administration may be related to the calcification of herniated lumbar discs. Key words: Lumbar disc herniation, percutaneous endoscopic lumbar discectomy, interlaminar approach, calcification

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

2019 ◽  
Vol 2019 ◽  
pp. 1-12 ◽  
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.

scholarly journals Comparison of postoperative outcomes between patients with positive and negative straight leg raising tests who underwent full-endoscopic transforaminal lumbar discectomy

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Fei-long Wei ◽  
Haoran Gao ◽  
Xiaodong Yan ◽  
Yifang Yuan ◽  
Shu Qian ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Outcomes ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Related Factors ◽  
Great Effectiveness ◽  
Significant Difference ◽  
Straight Leg Raising

Abstract Full-endoscopic transforaminal lumbar discectomy (FETD) is increasingly used in patients with lumbar disc herniation (LDH). There is little knowledge on the related factors, including the straight leg raising test (SLR), that influence the operation. Consecutive patients with LDH who came to our hospital from August 2015 to September 2016 and underwent FETD surgery were included. Four kinds of scores, including the VAS (lumbar/leg), ODI and JOA values, were measured and reassessed after FETD to assess the surgical outcomes. There was a statistically significant difference between the scores before surgery and at each postoperative follow-up. In addition, the increase in the JOA score postoperatively was statistically significant compared with that before surgery. There were statistically significant differences among the three subpopulations [patients considered SLR positive (0°–30°), SLR positive (31°–60°) and SLR negative (61°–)] in the changes in the VAS (leg), ODI and JOA values. However, there were no statistically significant differences among the three subpopulations [patients considered SLR positive (0°–30°), SLR positive (31°–60°) and SLR negative (61°–)] in the changes in VAS score (lumbar). FETD showed great effectiveness in treating patients with lumbar disc herniation. Patients who were SLR negative may receive greater benefit from FETD.

EFFICACY OF ANTIBIOTICS PROPHYLAXIS IN PATIENTS WITH LUMBAR DISC HERNIATION UNDERGOING LUMBAR DISCETOMY

2018 ◽  
Vol 8 (5) ◽  
pp. 14-19
Author(s):  
Tri Truong Van ◽  
Tri Tran Duc Duy ◽  
Khai Vo Le Quang
Keyword(s):  
Surgical Site Infection ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
University Hospital ◽  
Site Infection ◽  
Surgical Wound ◽  
A Prospective Study ◽  
Length Of Hospitalization

Introduction: Surgical wound infection in developing coutries is about 3%. Antibiotics prophylaxis may help to reduce the surgical site infection. The objective of this study was to evaluate the efficacy of antibiotics prophylaxis in patients with lumbar disc herniation who were treated with lumbar discectomy at Hue University hospital. Materials and Methods: A prospective study was conducted at Hue University hospital from March 2015 to May 2018 on 54 patients with lumbar disc herniation who were used antibiotics prophylaxis when undergoing discectomy. Results: The infection rate in our study was 0%. Antibiotics prophylaxis reduced the length of hospitalization as well as the medical cost. Conclusion: Antibiotics prophylaxis was effective in preventing surgical site infection despite the fact that the condition of operating rooms did not meet the standard rules. Key words: prophylaxis antibiotics, lumbar disc herniation

scholarly journals A Comparison of Percutaneous Endoscopic Lumbar Discectomy and Open Lumbar Microdiscectomy for Lumbar Disc Herniation in the Korean: A Meta-Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Manyoung Kim ◽  
Sol Lee ◽  
Hyeun-Sung Kim ◽  
Sangyoon Park ◽  
Sang-Yeup Shim ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Meta Analysis ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Lumbar Microdiscectomy ◽  
Surgical Methods ◽  
Endoscopic Lumbar Discectomy

Background. Among the surgical methods for lumbar disc herniation, open lumbar microdiscectomy is considered the gold standard. Recently, percutaneous endoscopic lumbar discectomy is also commonly performed for lumbar disc herniation for its various strong points. Objectives. The present study aims to examine whether percutaneous endoscopic lumbar discectomy and open lumbar microdiscectomy show better results as surgical treatments for lumbar disc herniation in the Korean population. Methods. In the present meta-analysis, papers on Korean patients who underwent open lumbar microdiscectomy and percutaneous endoscopic lumbar discectomy were searched, both of which are surgical methods to treat lumbar disc herniation. The papers from 1973, when percutaneous endoscopic lumbar discectomy was first introduced, to March 2018 were searched at the databases of MEDLINE, EMBASE, PubMed, and Cochrane Library. Results. Seven papers with 1254 patients were selected. A comparison study revealed that percutaneous endoscopic lumbar discectomy had significantly better results than open lumbar microdiscectomy in the visual analogue pain scale at the final follow-up (leg: mean difference [MD]=-0.35; 95% confidence interval [CI]=-0.61, -0.09; p=0.009; back: MD=-0.79; 95% confidence interval [CI]=-1.42, -0.17; p=0.01), Oswestry Disability Index (MD=-2.12; 95% CI=-4.25, 0.01; p=0.05), operation time (MD=-23.06; 95% CI=-32.42, -13.70; p<0.00001), and hospital stay (MD=-4.64; 95% CI=-6.37, -2.90; p<0.00001). There were no statistical differences in the MacNab classification (odds ratio [OR]=1.02; 95% CI=0.71, 1.49; p=0.90), complication rate (OR=0.72; 95% CI=0.20, 2.62; p=0.62), recurrence rate (OR=0.83; 95% CI=0.50, 1.38; p=0.47), and reoperation rate (OR=1.45; 95% CI=0.89, 2.35; p=0.13). Limitations. All 7 papers used for the meta-analysis were non-RCTs. Some differences (type of surgery (primary or revisional), treatment options before the operation, follow-up period, etc.) existed depending on the selected paper, and the sample size was small as well. Conclusion. While percutaneous endoscopic lumbar discectomy showed better results than open lumbar microdiscectomy in some items, open lumbar microdiscectomy still showed good clinical results, and it is therefore reckoned that a randomized controlled trial with a large sample size would be required in the future to compare these two surgical methods.

scholarly journals A Study of Lumbar Disc Herniation and Facet Joint Asymmetry

2019 ◽  
Vol 103 (1-2) ◽  
pp. 87-94
Author(s):  
Qi Lai ◽  
Yuan Liu ◽  
Runsheng Guo ◽  
Xin Lv ◽  
Qiang Wang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Facet Joint ◽  
Lumbar Disc ◽  
Patients Âgés ◽  
Lower Lumbar Spine ◽  
Significant Difference ◽  
Facet Joint Degeneration ◽  
Disc Herniations ◽  
Lumbar Facet

Purpose: To investigate the association of facet joint asymmetry with lumbar disc herniation at the lower lumbar spine. Methods: A total of 90 patients (ages 18–40 years) with single-level disc herniation (L3–L4, L4–L5, or L5–S1) were included in the study. Facet asymmetry was defined as a difference of 10° in facet joint angles between right and left sides. Normal discs in the same segment of other individuals were used as a control. Patients had facet asymmetry measured for L3 to S1 through 3.0T magnetic resonance imaging, and information was collected, including age, sex, degenerative degree of lumbar facet joints, and the presence or absence of lumbar disc herniation and type. Results: At the L3 to L4 level, 2 cases had facet asymmetry in 8 patients with lumbar disc herniation, compared with 17 cases of facet asymmetry in 82 patients without disc herniation (P = 0.7776, r = 0.030). At the L4 to L5 level, there were 21 cases of facet asymmetry in 45 patients with lumbar disc herniation, compared with 5 cases of asymmetry in 45 patients without disc herniation (P = 0.00019, r = 0.392). At the L5 to S1 level, there were 25 cases of facet asymmetry in 37 patients with lumbar disc herniation, compared with 11 cases of facet asymmetry in 53 patients without disc herniation (P = 0.0000, r = 0.492). There were 23 cases of facet asymmetry in 28 disc herniations of side type compared with 2 cases of facet asymmetry in 9 herniations of center type (P = 0.0008, r = 0.364). There was no significant difference in the relationship between age, facet joint degeneration, and lumbar facet joint asymmetry (P &gt; 0.05). Conclusion: Facet asymmetry is significantly associated with lumbar disc herniation at the L4 to L5 and the L5 to S1 levels, whereas there is an obvious association with the side type of lumbar disc herniation at the L5 to S1 level.

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