scholarly journals Biportal endoscopic discectomy for high-grade migrated lumbar disc herniation

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.

scholarly journals 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 ◽  
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.

Comparison of Outcomes Postoperation between Straight Leg Raising Test Negative and Positive Patients Who Underwent Percutaneous Transforaminal Endoscopic Discectomy for Lumbar Disc Herniation

2019 ◽  
Author(s):  
Feilong Wei ◽  
Haoran Gao ◽  
Yifang Yuan ◽  
Shu Qian ◽  
Quanyou Guo ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Related Factors ◽  
Significant Difference ◽  
Endoscopic Discectomy ◽  
Straight Leg Raising ◽  
Percutaneous Transforaminal Endoscopic Discectomy ◽  
Relevant Factors

Abstract Background: Percutaneous Transforaminal Endoscopic Discectomy is used increasingly in patients with Lumbar Disc Herniation. There is little knowledge on the related factors including SLR test influencing the operation. Therefore, we designed this prospective study to explore the relevant factors influencing postoperative effect of PTED surgery.Methods: Consecutive patients with LDH who came to our hospital from August 2015 to September 2016 and received PTED surgery. 4 kinds of scales including VAS (lumbar/leg), ODI and JOA were measured and reassessed at 1 day, 3 months, 6 months, 12months and 36 months after the PTED to assess their surgical outcomes. Results: All the patients had successful surgery. ODI and VAS (lumbar/leg) decreased in all patients and groups. And there was a statistically significant difference in each postoperative follow-up compared with that before surgery in every visit. In addition, the increase of JOA in postoperation was statistically significant compared with that before surgery. And, there is statistically significant difference between the three subpopulations (patients with SLR Positive (0°-30°), SLR Positive (31°-60°) and SLR Negative (61°-) in the changes of the scores of VAS(leg), ODI and JOA. However, there is no statistically significant difference between the three subpopulations (patients with SLR Positive (0°-30°), SLR Positive (31°-60°) and SLR Negative (61°--RRB- in the changes of the score of VAS(lumbar). Conclusions: PTED showed great effect on treating patients with lumbar disc herniation. And the main scale score such as VAS(leg). ODI and JOA showed that there is a statistically significant difference between the three subpopulations treated by PTED. Patients with SLR negative may get greater benefit from PTED.

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

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.

scholarly journals Short-term clinical outcomes of percutaneous transforaminal endoscopic discectomy in treating adolescents under 25 years old with massive lumbar disc herniation

2020 ◽  
Author(s):  
Hai-Chao He ◽  
Yong-jin Zhang
Keyword(s):  
Clinical Outcomes ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Spinal Instability ◽  
Lower Limb Pain ◽  
Endoscopic Discectomy ◽  
Adolescent Patients ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract Background: In the last decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, few studies have described the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in treating adolescent massive LDH. This study aims to evaluate the surgical outcomes of PTED in treating adolescent patients with massive LDH. Methods: Between October 2012 and December 2018, retrospective analysis of 13 adolescent patients with single segment massive LDH at the Department of Spinal Surgery of Affiliated Dongyang Hospital of Wenzhou Medical University. All patients were followed up for at least 12 months (range 12–20 months). The patients’ lower limb pain was evaluated using visual analogue scale (VAS) scores and the Oswestry Disability Index (ODI). Patient satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively, at 3 days, 1 months, 3 months, 6 month and 12 months postoperatively. Results: The VAS score for leg pain was 7.08 ±1.12 preoperatively and 3.23±1.01, 3.0 ± 1.01, and 2.62 ± 0.51, and 2.32± 0.48, and 1.46± 0.52, at 3 days, 1 months, 3 months, 6 months and 12 months postoperatively respectively. The ODI scores was 51.51 ±3.08 preoperatively and 21.74±1.15, 14.81 ± 1.50, and 2.78 ± 0.64, at 3 months, 6 months and 12 months postoperatively respectively. These postoperative scores were all significantly different when compared with preoperative scores (P < 0.001). According to the modified MacNab outcome scale, excellent was obtained in 7 patients, good was obtained in 5 patients, and fair was obtained in 1 patient, and 92.31% of these patients had excellent and good outcomes at the final follow-up. There were no complications related to surgery, and no spinal instability was detected. Conclusion: The PTED is an effective and safe surgical method for the treatment of adolescent patients with massive LDH, but high-quality randomized controlled trials are still required to further verify these findings.

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

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.

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

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.

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.

Is the Effect of Intervertebral Foramen Endoscopic Surgery on Adjacent Segmental Degeneration Better Than That of Open Surgery?

2021 ◽  
Author(s):  
wang shunmin ◽  
kaiqiang sun ◽  
aigang liu ◽  
rongzi chen ◽  
xi luo ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Endoscopic Surgery ◽  
Lumbar Disc ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Intervertebral Foramen ◽  
Significant Difference ◽  
Endoscopic Discectomy

Abstract Background To compare the clinical outcomes of transforaminal lumbar interbody fusion (TLIF) and endoscopic discectomy in the treatment of postoperative adjacent segment degeneration in patients with lumbar disc herniation. Methods From 2014 to 2017, 87 patients who were diagnosed with single-level lumbar disc herniation (LDH) and received surgery of TLIF (group X, n = 43) or endoscopic discectomy (group F, n = 44) were retrospectively analyzed. X-ray, MRI, CT and clinical symptoms were recorded before operation and at the last follow-up. The neurological function was originally evaluated by the (JOA) score of the Japanese Orthopaedic Association. Radiological evaluation included the height of intervertebral space (HIS), intervertebral foramen height (FH), intervertebral foramen area (FA), lumbar lordosis (CA) and intervertebral disc degeneration pfirrmann score.Results There was no significant difference in average operation age, JOA improvement rate, reoperation rate and complications between the two groups. The average blood loss, average hospital stays and average operation time in group F were lower than those in group X. During the last follow-up, HIS, CA and FA decreased in both groups, and the changes in group X were more significant than those in group X (P < 0.05). There was no significant difference in postoperative FH between the two groups, but it decreased more in group X (P < 0.05).Conclusion Both TLIF and endoscopic surgery can achieve good results in the treatment of LDH, but the risk of lumbar adjacent segment degeneration after intervertebral foraminal surgery is lower.

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