Percutaneous endoscopic discectomy: surgical technique and preliminary results compared to microsurgical discectomy

1993 ◽  
Vol 78 (2) ◽  
pp. 216-225 ◽  
Author(s):  
H. Michael Mayer ◽  
Mario Brock
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Lumbar Disc ◽  
Motor Deficits ◽  
Low Back ◽  
Content Type ◽  
Sensory Deficits ◽  
Endoscopic Discectomy ◽  
Disc Herniations ◽  
Fine Print

✓ Percutaneous endoscopic discectomy is a new technique for removing “contained” lumbar disc herniations (those in which the outer border of the anulus fibrosus is intact) and small “noncontained” lumbar disc herniations (those at the level of the disc space and occupying less than one-third of the sagittal diameter of the spinal canal) through a posterolateral approach with the aid of specially developed instruments. The technique combines rigid straight, angled, and flexible forceps with automated high-power suction shaver and cutter systems. Access can thus be gained to the dorsal parts of the intervertebral space where the disc herniation is located. Percutaneous endoscopic discectomy is monitored using an endoscope angled to 70° coupled with a television and video unit and is performed with the patient under local anesthesia and an anesthesiologist available if needed. Its indication is restricted to discogenic root compression with a minor neurological deficit. Two groups of patients with contained or small noncontained disc herniations were treated by either percutaneous endoscopic discectomy (20 cases) or microdiscectomy (20 cases). Both groups were investigated in a prospective randomized study in order to compare the efficacy of the two methods. The disc herniations were located at L2–3 (one patient), L3–4 (two patients), or L4–5 (37 patients). There were no significant differences between the two groups concerning age and sex distribution, preoperative evolution of complaints, prior conservative therapy, patient's occupation, preoperative disability, and clinical symptomatology. Two years after percutaneous endoscopic discectomy, sciatica had disappeared in 80% (16 of 20 patients), low-back pain in 47% (nine of 19 patients), sensory deficits in 92.3% (12 of 13 patients), and motor deficits in the one patient affected. Two years after microdiscectomy, sciatica had disappeared in 65% (13 of 20 patients), low-back pain in 25% (five of 20 patients), sensory deficits in 68.8% (11 of 16 patients), and motor deficits in all patients so affected. Only 72.2% of the patients in the microdiscectomy group had returned to their previous occupation versus 95% in the percutaneous endoscopic discectomy group. Percutaneous endoscopic discectomy appears to offer an alternative to microdiscectomy for patients with “contained” and small subligamentous lumbar disc herniations.

Unilateral removal of pars interarticularis

2005 ◽  
Vol 2 (3) ◽  
pp. 279-288 ◽  
Author(s):  
Gabriel C. Tender ◽  
Richard V. Baratta ◽  
Rand M. Voorhies
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Short Form ◽  
Mcgill Pain Questionnaire ◽  
Foraminal Stenosis ◽  
Low Back ◽  
Content Type ◽  
Pars Interarticularis ◽  
Disc Herniations ◽  
Fine Print

Object. Lumbar radiculopathy secondary to foraminal entrapment can be treated by unilateral removal of the overlying pars interarticularis. The authors prospectively evaluated the outcome after this procedure. Methods. Thirty-six consecutive patients underwent unilateral resection of the pars interarticularis between August 1999 and July 2002. In 18 patients acute foraminal disc herniations compressed the nerve root against the superior pedicle; in the other 18 foraminal stenosis was secondary to degenerative changes. All patients, at each visit, completed the following questionnaires: visual analog scale for overall, leg, and back pain; the Prolo Functional Economic Rating scale; and the Pain Rating Index (PRI) of the Short-Form McGill Pain Questionnaire. At 1 year, leg pain improved in 33 patients (91%). Low-back pain appeared or worsened in eight patients (22%; one in the acute herniation group and seven in the chronic degenerative group). Only one patient required lumbar fusion for pain. The Prolo economic and function scores improved in 21 (58%) and 27 (75%) patients, respectively. The PRI scores improved in 30 cases (83%). No spondylolisthesis was observed at any level at which resection had been performed. Conclusions. Unilateral removal of the pars interarticularis is effective in relieving lumbar radicular symptoms in patients with intraforaminal entrapment. The incidence of low-back pain in patients with acute foraminal disc herniations does not increase as a result of this procedure. In patients with degenerative foraminal stenosis, unilateral resection of the pars interarticularis may be a better alternative to facetectomy and segmental fusion. This procedure may be a useful tool in spine surgery.

Dermoid tumors of the spinal cord

1970 ◽  
Vol 33 (6) ◽  
pp. 676-681 ◽  
Author(s):  
Ian C. Bailey
Keyword(s):  
Spinal Cord ◽  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina ◽  
Complete Removal ◽  
Cord Compression ◽  
Conus Medullaris ◽  
Low Back ◽  
Content Type ◽  
Fine Print

✓ This is an analysis of 10 cases of dermoid tumor occurring in the spinal canal (8 lumbar and 2 thoracic). Low-back pain was the commonest presenting symptom, especially if the tumor was adherent to the conus medullaris. Other complaints included urinary dysfunction and motor and sensory disturbances of the legs. Clinical and radiological evidence of spina bifida was found in about half of the cases and suggested the diagnosis of a developmental type of tumor when patients presented with progressive spinal cord compression. At operation, the tumors were often found embedded in the conus medullaris or firmly adherent to the cauda equina, thus precluding complete removal. Evacuation of the cystic contents, however, gave lasting relief of the low-back pain and did not cause any deterioration in neurological function. In a follow-up study, ranging from 1 to 15 years, virtually no improvement in the neurological signs was observed. On the other hand, only one case has deteriorated due to recurrence of tumor growth.

scholarly journals Comparison of Clinical Outcomes of Two-Level PELD and Foraminoplasty PELD for Highly Migrated Disc Herniations: A Comparative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Xinbo Wu ◽  
Guoxin Fan ◽  
Shisheng He ◽  
Xin Gu ◽  
Yunfeng Yang
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Nucleus Pulposus ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Low Back ◽  
Satisfaction Rate ◽  
Disc Herniations

Objective. The aim of this study is to compare the clinical outcomes of two-level percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty PELD in treating highly migrated lumbar disc herniations. Methods. Patients with highly migrated lumbar disc herniations were enrolled from May 2014 to June 2016. Low back pain and leg pain were evaluated by the Visual Analog Scale (VAS), and functional outcomes were assessed with the Oswestry Disability Index (ODI). The satisfaction rate of clinical outcomes was assessed according to the modified MacNab criteria. In addition, the intraoperative duration and postoperative complications were also recorded. Results. Forty patients, 14 cases in two-level PELD group and 26 cases in foraminoplasty PELD group, were included. The VAS scores of low back pain (P=0.67) and leg pain (P=0.86), as well as the ODI scores (P=0.87), were comparative between two-level PELD and foraminoplasty PELD groups. The satisfaction rate of clinical outcomes based on the modified MacNab criteria in the two-level PELD group was equivalent to that in foraminoplasty PELD group (92.9% versus 92.3%, P=0.92). In addition, the intraoperative duration of two-level PELD group was longer than that of foraminoplasty PELD group (80.2 ± 6.6 min versus 64.1 ± 7.3 min, P<0.01). The postoperative complications in the two-level PELD group (postoperative dysesthesia: N = 1) were relatively fewer as compared to those in the foraminoplasty PELD group (postoperative dysesthesia: N = 1; recurrence: N = 1; nucleus pulposus residues: N = 1). Conclusions. Both two-level PELD and foraminoplasty PELD are safe and effective surgical procedures for the patients with highly migrated lumbar disc herniations. Moreover, the two-level PELD technique has merits in reducing the incidence of postoperative nucleus pulposus residue.

Nonsurgically managed patients with degenerative spondylolisthesis: a 10- to 18-year follow-up study

2000 ◽  
Vol 93 (2) ◽  
pp. 194-198 ◽  
Author(s):  
Shunji Matsunaga ◽  
Kosei Ijiri ◽  
Kyoji Hayashi
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Clinical Symptoms ◽  
Degenerative Spondylolisthesis ◽  
Low Back ◽  
Indications For Surgery ◽  
Initial Examination ◽  
Content Type ◽  
Fine Print

Object. Controversy exists concerning the indications for surgery and choice of surgical procedure for patients with degenerative spondylolisthesis. The goals of this study were to determine the clinical course of nonsurgically managed patients with degenerative spondylolisthesis as well as the indications for surgery. Methods. A total of 145 nonsurgically managed patients with degenerative spondylolisthesis were examined annually for a minimum of 10 years follow-up evaluation. Radiographic changes, changes in clinical symptoms, and functional prognosis were surveyed. Progressive spondylolisthesis was observed in 49 patients (34%). There was no correlation between changes in clinical symptoms and progression of spondylolisthesis. The intervertebral spaces of the slipped segments were decreased significantly in size during follow-up examination in patients in whom no progression was found. Low-back pain improved following a decrease in the total intervertebral space size. A total of 84 (76%) of 110 patients who had no neurological deficits at initial examination remained without neurological deficit after 10 years of follow up. Twenty-nine (83%) of the 35 patients who had neurological symptoms, such as intermittent claudication or vesicorectal disorder, at initial examination and refused surgery experienced neurological deterioration. The final prognosis for these patients was very poor. Conclusions. Low-back pain was improved by restabilization. Conservative treatment is useful for patients who have low-back pain with or without pain in the lower extremities. Surgical intervention is indicated for patients with neurological symptoms including intermittent claudication or vesicorectal disorder, provided that a good functional outcome can be achieved.

Syndromes associated with protrusion of upper lumbar intervertebral discs

1973 ◽  
Vol 38 (4) ◽  
pp. 499-503 ◽  
Author(s):  
Paul Gutterman ◽  
Henry A. Shenkin
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Discs ◽  
Thigh Pain ◽  
Low Back ◽  
Good Recovery ◽  
Content Type ◽  
Anterior Thigh ◽  
Acute Paraplegia ◽  
Fine Print

✓ This report reviews a series of 69 patients operated on for herniations of upper lumbar intervertebral discs and identifies four syndromes related to the principal complaint. These are, in order of frequency, anterior thigh pain, low-back pain only, sciatica, and acute paraplegia. Overall, 78% had satisfactory relief of pain and 93% were improved following laminectomy. Satisfactory results were more common with protrusions at L3–4 than at L2–3. Patients in whom the onset was sciatica had a higher percentage of satisfactory results (94%) than those with anterior thigh pain (70%) or low-back pain alone (80%). Neither of the patients with a paraplegic onset had a good recovery even after removal of the extruded disc.

scholarly journals Efficacy of Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Patients Undergoing Lumbar Disc Herniation With Positive Nerve Root Sedimentation Sign: a Retrospective Case-Control Study

2020 ◽  
Author(s):  
Luoyi Deng ◽  
Hua Yang ◽  
Miao Liu ◽  
Jin Deng ◽  
Guoxuan Peng ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Pain Relief ◽  
Nerve Root ◽  
Lumbar Disc ◽  
Low Back ◽  
Negative Group ◽  
Positive Group ◽  
Endoscopic Discectomy ◽  
Percutaneous Transforaminal Endoscopic Discectomy

Abstract Background: To investigate the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of patients who were diagnosed with lumbar disc herniation (LDH) with positive nerve root sedimentation sign (NRSS).Methods: A total of 86 patients who underwent LDH were recruited and divided into NRSS-positive group (n=49) and NRSS-negative group(n=37). The visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry Disability Index (ODI) were used to evaluate the low back pain and functional recovery and were compared between the two groups.Results: There were no significant differences in the demographic parameters between the two groups. The average area of the dural sac compression in the NRSS-positive group was significantly higher than that in the NRSS-negative group. Patients with a positive NRSS showed a better low back pain relief than those with a negative NRSS at 1 week and 1 month after surgery. The JOA and ODI in the NRSS-positive group were better than those in the NRSS-negative group at 3 months and 6 months postoperatively. The apparent efficiency of JOA and the excellent and good rate of ODI in the negative group was lower than that in the positive group at 6 months after surgery. Conclusions: Patients undergoing LDH with a positive NRSS showed better pain relief and functional recovery than those with a negative NRSS. The present study suggested that NRSS might be a valuable sign and associated with better clinical outcomes in patients undergoing LDH with the treatment of PTED.

scholarly journals Posterior epidural migration of a lumbar disc herniation

2020 ◽  
Vol 11 ◽  
pp. 4
Author(s):  
Meryem Himmiche ◽  
Khalid Chakour ◽  
Mohammed El Faiz Chaoui ◽  
Mohammed Benzagmout
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Low Back ◽  
Case Description ◽  
Disc Material ◽  
Disc Herniations ◽  
History Of

Background: Posterior epidural migration of a lumbar disc fragment (PEMLDF) refers to the dorsal migration of disc material around the thecal sac that can lead to radiculopathy and/or cause a cauda equina syndrome. It is rare and the diagnosis is often just established intraoperatively. Case Description: A 50-year-old male with a chronic history of low back pain and psychosis presented with PEMLDF originating at the L4–L5 level. Conclusion: Lumbar disc herniations rarely present as PEMLDF resulting in symptoms varying from radiculopathy to cauda equina syndrome. These should be included among the differential diagnostic considerations for dorsolateral epidural lesions.

scholarly journals Epidemiology of lumbar disc herniations in adults with low back pain in Enugu, Nigeria

2019 ◽  
Vol 6 (1) ◽  
pp. 1
Author(s):  
Godson E. Anyanwu ◽  
Remigius T. Ekwunife ◽  
Emmanuel C. Iyidobi ◽  
Cajetan U. Nwadinigwe ◽  
Henry C. Ekwedigwe ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Intervertebral Disc ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Low Back ◽  
Inclusion Criteria ◽  
Laptop Computer ◽  
Disc Herniations

<p class="abstract"><strong>Background:</strong> Lumbar intervertebral disc herniation is used to describe a spectrum of anatomical abnormalities involving disc extension beyond the interspace. It follows a tear in the annulus fibrosus of the intervertebral disc. It is one of the most common causes of low back pain among adults. The study aims to assess the epidemiological pattern of lumbar disc herniations among adults with low back pain in Enugu urban.</p><p class="abstract"><strong>Methods:</strong> The study was a prospective study at National Orthopedic Hospital Enugu and Annunciation Specialist Hospital Enugu. Following ethical approval and written informed consent, patients who met the inclusion criteria were consecutively recruited. The MRI scans of the participants were viewed using DICOM® (Digital Imaging and Communications in Medicine) software on laptop computer. The data included the patients’ demographics, functional disability index for back pain, weight, height, the anatomical level(s) and site(s) of the herniated disc among other parameters.<strong></strong></p><p class="abstract"><strong>Results:</strong> A total of 81 subjects who met the inclusion criteria were included and analyzed using SPSS version 20.0. The mean age of the subjects is 52.99±13.13 years. The most common affected age group is 51-60 years (27.2%). Majority of the subjects (68; 84%) had multiple level herniations which usually includes L4 level(74; 91.4%).</p><p class="abstract"><strong>Conclusions:</strong> That multilevel lumbar disc herniation is far more common than single level herniation with a prevalence of 84% among adults with low back pain in Enugu urban. That, there is statistically significant association of lumbar disc herniation and increasing age.</p>

Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations

2001 ◽  
Vol 94 (2) ◽  
pp. 216-220 ◽  
Author(s):  
Sean M. Lew ◽  
Thomas F. Mehalic ◽  
Kristin L. Fagone
Keyword(s):  
Return To Work ◽  
Lumbar Disc ◽  
Intervertebral Discs ◽  
Work Status ◽  
Outpatient Basis ◽  
Content Type ◽  
Endoscopic Discectomy ◽  
Disc Herniations ◽  
Far Lateral ◽  
Fine Print

Object. Far-lateral (extraforaminal) and foraminal disc herniations comprise up to 11% of all herniated intervertebral discs. Operative management can be technically difficult, and the optimum surgical treatment remains controversial. Accessing these lateral disc herniations endoscopically via a percutaneous transforaminal approach offers several theoretical advantages over the more traditional procedures. The object of this study was to assess the safety and efficacy of treating patients with far-lateral and foraminal disc herniations via a percutaneous transforaminal endoscopic approach. Methods. A retrospective analysis was performed of 47 consecutive patients who underwent surgery via this approach. All procedures were performed after induction of a local anesthetic on an outpatient basis. Outcome was measured with Macnab criteria and by determining a patient's return-to-work status. The median follow-up period was 18 months (range 4–51 months). Excellent or good outcome was obtained in 40 (85%) of 47 patients. Of the 38 patients working before the onset of symptoms, 34 (90%) returned to work. Five patients (11%) experienced poor outcomes and subsequently underwent open procedures at the same level. Of the 10 recipients of Workers' Compensation, Macnab criteria indicated a significantly worse outcome (70% excellent or good), but an excellent return-to-work status was maintained (90%). There were no complications. Conclusions. Transforaminal percutaneous endoscopic discectomy is safe and efficacious in the treatment of far-lateral and foraminal disc herniations.

Extradural lipomatosis simulating an acute herniated nucleus pulposus

1982 ◽  
Vol 57 (4) ◽  
pp. 559-562 ◽  
Author(s):  
Carol R. Archer ◽  
Kenneth R. Smith
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Acute Exacerbation ◽  
Signs And Symptoms ◽  
Low Back ◽  
Review Of The Literature ◽  
Content Type ◽  
History Of ◽  
Herniated Nucleus Pulposus ◽  
Fine Print

✓ A 48-year-old laborer presented with a 1-year history of low-back pain radiating into the posterior aspects of both thighs. Two weeks before admission, acute exacerbation resulted in signs and symptoms of compressive radiculopathy at L-5. Myelography revealed concentric constriction of the lower thecal sac due to abundant fat, as shown by computerized tomography. Laminectomy produced immediate relief of pain. The significance of these findings and a review of the literature are presented.

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