Comparation of Percutaneous Endoscopic Lumbar Discectomy between Transforaminal Approach and Interlaminar Approach on Lumbar Disc Herniation of L4-L5: An Observational Study

2020 ◽  
Vol 103 (12) ◽  
pp. 1277-1283
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Demographic Data ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Interlaminar Approach ◽  
Endoscopic Lumbar Discectomy ◽  
Approach Group

Objective: To evaluate the clinical outcomes and complications of post percutaneous endoscopic lumbar discectomy (PELD) via transforaminal (TF) approach and interlaminar (IL) approach in patients with lumbar disc herniation L4-L5 level. Materials and Methods: Eighty-five patients diagnosed with lumbar disc herniation on L4-L5 level and who underwent PELD were non-randomly recruited and assigned into two groups. Fifty-two patients underwent PELD via the IL approach and thirty-three patients underwent PELD via the TF approach. The demographic data, resting visual analog scale (VAS), activity VAS, Oswestry Disability Index (ODI), and complications were obtained before the operation, and at follow-up on day 1, and at 2-, 6-, 12-, and 24-months post operation. Results: Resting VAS and activity VAS statistically significantly declined in both groups (p=0.001). Activities of daily living (ADL) as assessed by ODI increased significantly in both groups (p=0.001). However, there was no significant differences between the groups. The TF approach group had significant more dysesthesia and re-surgery (p=0.009, p=0.05, respectively) than the IL approach group. The total re-surgery rate during the two years of follow-up was in the 9.4%. Conclusion: PELD is a safe and effective minimal invasive spine surgery. The clinical results via both approaches have similar result but PELD via the TF approach had higher post-operative complications than via the IL approach. Additionally, PELD via the TF approach required higher skill to puncture and there is a steeper learning curve than PELD via the IL approach. Keywords: Percutaneous endoscopic lumbar discectomy, PELD, Transforaminal, Interlaminar

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 Full-Endoscopic Lumbar Discectomy for Two Contiguous Level Adolescent Lumbar Disc Herniation

2020 ◽  
Author(s):  
lu mao ◽  
Bin Zhu ◽  
Xiaotao Wu ◽  
Feng Wang ◽  
Cong Zhang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Visual Analog Scale ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Analog Scale ◽  
One Stage ◽  
Interlaminar Approach ◽  
Endoscopic Lumbar Discectomy

Abstract Background: Symptomatic lumbar disc herniation is rarely seen among adolescents. Adolescent lumbar disc herniation (ALDH) accounts for 0.5% to 6.8% of all those treated. Evidently, to our knowledge, no studies have emphasized the operative technique to treat two contiguous level adolescent lumbar disc herniation simultaneously. In this study, we aim to investigate the feasibility and advantages of one-stage full-endoscopic lumbar discectomy（FELD）for two contiguous level ALDH. This is the first paper, to my knowledge, dealing with two contiguous level ALDH simultaneously with one-stage full-endoscopic lumbar discectomy.Methods: Between January 2014 and December 2019, patients received FELD surgery for lumbar disc herniation (LDH) in 2 main minimally invasive spine center of China were selected for screening of this study. Data of 5877 cases were retrospectively analyzed (2780 cases and 3097 cases, respectively). The inclusion criteria were patient under 21-year old, two contiguous level symptomatic lumbar disc herniation received one-stage 2 level PELD surgery. Visual analog scale (VAS) scores and modified Macnab criteria were used to assess the preoperative and postoperative clinical results.Results: 11 patients were enrolled in this study (0.19%,11/5877), 8 patients were male and 3 were female. 9 patients with LDH in the same side underwent single-incision 2 level FELD surgery via transforaminal approach. 2 patients with LDH in different side underwent FELD surgery via combined transforaminal and interlaminar approach. There were no immediate perioperative complications. The visual analog scale (VAS) decreased significantly in both early and late follow-up evaluations and these score demonstrated significant improvement in late follow-up (P <0.01). For the modified MacNab criteria, the final outcome results were excellent in 9 patients (81.8%), good in 1 patients (0.9%), fair in1 patients (0.9%), and the overall success rate was 90.9%.Conclusion: One-stage full-endoscopic lumbar discectomy for 2 level symptomatic ALDH is an effective and less invasive method, which can be considered as an alternative good technique for selected adolescent patients.

scholarly journals Percutaneous Endoscopic Lumbar Discectomy as an Alternative to Open Lumbar Microdiscectomy for Large Lumbar Disc Herniation

2016 ◽  
Vol 19 (2;2) ◽  
pp. E291-E300 ◽  
Author(s):  
Jin-Sung Kim
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Disc Height ◽  
Herniated Disc ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy

Background: Remarkable advancements in endoscopic spinal surgery have led to successful outcomes comparable to those of conventional open surgery. Large lumbar disc herniation (LLDH) is a serious condition, resulting in higher surgical failure when accessing the herniated disc. Objectives: This study compared the outcomes of LLDH treated with percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM). Study Design: Retrospective assessment. Methods: This retrospective observational study was conducted from January 2011 to June 2012. Forty-four consecutive patients diagnosed with LLDH without cauda equina syndrome who were scheduled to undergo spinal surgery were included. LLDH was defined as herniated disc fragment occupying > 50% of the spinal canal. Clinical outcomes were evaluated using a visual analogue scale (VAS, 0 – 10), functional status was assessed using the Oswestry Disability Index (ODI, 0 – 100%) at 1, 6, and 24 months postoperatively and surgical satisfaction rate (0 – 100%) at final follow up. Radiological variables were assessed by plain radiography. Results: Forty-three patients were included; 20 and 23 patients underwent PELD and OLM, respectively. Both groups exhibited significant improvements in leg and back pain postoperatively (P < 0.001). Although there was no significant difference in leg pain improvement between the groups, improvement in back pain was significantly higher in the PELD group than in the OLM group (4.9 ± 1.5 vs. 2.5 ± 1.0, P < 0.001). The surgical satisfaction rate of the PELD group was significantly higher than that of the OLM group (91.3% ± 6.5 vs. 84.3% ± 5.2, P < 0.001). Mean operating time, hospital stay, and time until return to work were significantly shorter in the PELD group than in the OLM group (67.8 vs. 136.7 minutes, 1.5 vs. 7.2 days, and 4.2 vs. 8.6 weeks; P < 0.001). Disc height (%) decreased significantly from 23.7 ± 3.3 to 19.1 ± 3.7 after OLM (P < 0.001), but did not change significantly after PELD (23.6 ± 3.2 to 23.4 ± 4.2; P = 0.703). The segmental angle of the operated level increased from 10.3° to 15.4° in the PELD group, which was significantly higher than that in the OLM group (9.6° to 11.6°; P = 0.038). In the OLM group, there was one case of fusion due to instability. In the PELD group, one case required revision surgery and another case experienced recurrence. There were no perioperative complications in either group. Limitation: The study was retrospective with a small sample size and short follow-up period. Conclusion: PELD can be an effective treatment for LLDH, and it is associated with potential advantages, including a rapid recovery, improvements in back pain, and disc height preservation. Key words: Large lumbar disc herniation, percutaneous endoscopic lumbar discectomy, microdiscectomy, back pain, disc height

scholarly journals Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated Lumbar Disc Herniation

2017 ◽  
Vol 1 (21;1) ◽  
pp. E75-E84 ◽  
Author(s):  
Zhong-Liang Deng
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Transforaminal Approach ◽  
Interlaminar Approach ◽  
Operation Duration ◽  
The Mean ◽  
Endoscopic Lumbar Discectomy

Background: Percutaneous endoscopic lumbar discectomy (PELD) has been growing in popularity for the treatment of lumbar disc herniation (LDH) due to its irreplaceable advantages over conventional open surgery. Compared with common lumbar disc herniations, discectomy of highly migrated LDH by PELD is known to be very difficult. Highly migrated lumbar disc herniation has long been a challenge for its specific characteristics. Three approaches for PELD have been applied to access a highly migrated LDH, including an interlaminar approach (IL), transforaminal approach (TF), and contralateral transforaminal approach (CTF). However, none of the existing research has systematically described the selection of the most appropriate procedure from the 3 approaches or the individualization of an operative procedure in different cases. Objectives: The purpose of this study was to present a detailed surgical approach selection and individualization of procedure in the treatment of highly migrated LDH with PELD. We also mean to compare the outcomes of patients with highly migrated LDH treated with PELD by the 3 approaches. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: In our retrospective analysis between March 2011 and March 2013, 73 patients with single level highly migrated LDH received PELD. Clinical outcomes were assessed with the visual analogue scale (VAS) score, the modified MacNab criteria, and the Oswestry disability index (ODI). Relevant data such as operation duration and fluoroscopy frequency of the 3 operative approaches were recorded. Results: The mean operating time of IL was 56 minutes, compared with 64 minutes for TF and 112 minutes for CTF. The mean intraoperative fluoroscopy times were 5.5 for IL, 9.7 for TF, and 14.6 for CTF. In each group, the mean VAS and ODI after surgery and 3 months after surgery improved dramatically compared with preoperative counterparts. However, the difference between postoperative results and the results 3 months after surgery was not significant (P > 0.05). The overall excellent rate was 90.4% according to the modified MacNab criteria; there was no significant statistical difference between the 3 operative routes. Operative complications occurred in 3 patients (2 after IL and one after CTF, 3 of 73, 4.1%). Limitations: This study is limited by its sample size. Conclusion: In our research, PELD with all 3 approaches was similarly effective to highly migrated disc herniation. The CTF approach required the longest operation duration and the most intraoperative times. On the contrary, the least operation time and radiographfrequency was required with the IL approach. In addition, we came to a conclusion of surgery approach selection when it comes to varied HM-LDH. Key words: Highly migrated, lumbar disc herniation, percutaneous endoscopic lumbar discectomy, minimally invasive treatment Pain Physician 2017;

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 A Pilot Study of Full-Endoscopic Annulus Fibrosus Suture Following Lumbar Discectomy: Technique Notes and One-Year Follow-Up

2020 ◽  
Vol 5;23 (9;5) ◽  
pp. E497-E505
Author(s):  
Zhen-zhou Li
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Annulus Fibrosus ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Group I ◽  
Interlaminar Approach ◽  
One Year ◽  
Endoscopic Lumbar Discectomy

Background: An annulus fissure or defect will inevitably be left on the posterior annulus fibrosus after almost all kinds of lumbar discectomy, which may lead to unsatisfying postoperative pain relief and recurrence of the disc herniation. Objective: The objective of this research is to introduce the technique of full-endoscopic annulus fibrosus suture following lumbar discectomy through the transforaminal or interlaminar approach, and to analyze the clinical outcome of full-endoscopic lumbar discectomy and annulus fibrosus suture. Study Design: This study used a prospective cohort design. Setting: The research was conducted in a hospital and outpatient surgery center. Methods: A total of 50 patients with noncontained lumbar disc herniation treated with full-endoscopic lumbar discectomy and annulus fibrosus suture were treated in our department between January 2018 and November 2018. Full-endoscopic single-stitch suture via the transforaminal approach (Group T) or double-stitch suture via the interlaminar approach (Group I) was selected according to the level of lesion. Lumbar magnetic resonance imaging (MRI) was reexamined on the second day and 3 months after operation to evaluate the completeness of the discectomy and the adequacy of nerve decompression. Patients were followed up on the second day, 3 months, 6 months, and one year after operation to evaluate the relief of low back pain and leg pain, using a visual analog scale (VAS, 100-point scale). At 3 months, 6 months, and one year after operation, the patients were followed up for recovery of lumbar spine function, using the Oswestry Disability Index (ODI). At the one-year follow-up, the MacNab score was used to evaluate the clinical outcome, and the recovery of nerve root function (sensation, muscle strength, and reflex) was recorded. Results: All operations were successfully completed, including 27 cases in Group T and 23 cases in Group I. There were no surgical complications and no recurrence of lumbar disc herniation. Lumbar MRI reexaminations of all patients showed that the herniated disc was completely removed and the nerves were fully decompressed. Postoperative low back pain and leg pain were significantly relieved, and the ODI score was significantly improved (P < .01) in both groups. At the one-year follow-up, the excellent and good rates as measured by the MacNab score were 92.6% in Group T and 91.3% in Group I with no significant difference between the 2 groups (P > .05). The impaired sensation and muscle strength in the low extremities of evolved nerve root of the 2 groups of patients recovered significantly at the oneyear follow-up (P < .01), but the tendon reflex did not recover significantly (P > .05). Limitations: This is an observational cohort study with relatively small sample sizes and short-term follow-up. Conclusions: Full-endoscopic lumbar discectomy and annulus fibrosus suture through either the transforaminal or interlaminar approach are safe and effective minimally invasive spinal surgery techniques that can reduce the recurrence rate of lumbar disc herniation after full-endoscopic lumbar discectomy. Keywords: Annulus fibrosus suture; full-endoscope; lumbar disc herniation; lumbar discectomy; minimally invasive spinal surgery

scholarly journals Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases

2018 ◽  
Vol 1 (21;1) ◽  
pp. E401-E408 ◽  
Author(s):  
Byapak Paudel
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Surgical Success ◽  
Disc Herniations ◽  
Endoscopic Lumbar Discectomy

Background: Lumbar disc herniation (LDH) is being treated with limited indication by percutaneous full endoscopic lumbar discectomy. However, microscopic lumbar discectomy (MLD) is still considered as a gold standard. Objective: With the advances in spinal endoscopic instruments and surgical techniques, all LDHs have now become operable with percutaneous full endoscopic lumbar discectomy procedure. We report the results of percutaneous full endoscopic lumbar discectomy (PELD) for all patients diagnosed with LDH, including severely difficult and extremely difficult LDH cases who visited our clinic with leg pain and lower back pain. Study Design: Retrospective study of consecutive prospective patients. Setting: Spine center, Nanoori Suwon Hospital, Suwon, Korea. Methods: Electronic medical records of 98 consecutive patients (104 levels) who underwent surgery from October 2015 to May 2016, by PELD for different LDHs either by percutaneous endoscopic transforaminal lumbar discectomy (PETLD) or percutaneous endoscopic interlaminar lumbar discectomy (PEILD) approach were reviewed retrospectively. The L5-S1 level was accessed with PEILD approach and the other levels were accessed with PETLD approach. Outcomes were analyzed utilizing the visual analog scale (VAS), Oswestry disability index (ODI), Mac Nab Criteria and endoscopic surgical success grade/score. Results: There were 75 (72.1%) men and 29 (27.9%) women patients with a mean age of 48.12 ± 15.88 years. Follow-up range from a minimum of 10 to 15 months (mean 12.77 ± 1.84 months). Most of the LDHs were located at L4-5 level. There were 76% severely difficult and extremely difficult cases. PETLD was the choice of approach in most of the cases (78 cases, 75%). VAS decreased significantly. ODI improved from preoperative 54.67 ± 7.52 to 24.50 ± 6.45 at last follow-up. 96.1% good to excellent result was obtained as per Mac Nab criteria. 98.1% of patients were managed with a successful to completely successful grade according to the endoscopic surgical success grading/ scoring. Two cases (1.9%) developed transient motor weakness. Limitation: Retrospective analysis of consecutive prospective patients. Conclusion: With more than 96% success (98.1% as per endoscopic success grading/scoring) all kinds of LDHs, including severely difficult and extremely difficult LDHs, are accessible by the PELD (PETLD and PEILD) technique. PELD can now be considered an alternative to microscopic lumbar discectomy (MLD) in the treatment of all kinds of disc herniations with the added benefits of keyhole surgery even for severely difficult and extremely difficult LDH cases. Key words: Lumbar disc herniation (LDH), percutaneous endoscopic lumbar discectomy (PELD), percutaneous endoscopic transforaminal lumbar discectomy (PETLD), percutaneous endoscopic interlaminar discectomy (PEILD), evolution of PELD, difficult LDH, highly migrated LDH, high canal compromised LDH, revision LDH, LDH with discal cyst, calcified LDH

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