scholarly journals Percutaneous Endoscopic Lumbar Discectomy as an Emergent Surgery for Cauda Equina Syndrome Caused by Lumbar Disc Herniation

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. E259-E264
Author(s):  
Yuntao Wang
Keyword(s):  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
One Year ◽  
The One ◽  
Endoscopic Lumbar Discectomy ◽  
Emergent Surgery

Background: Cauda equina syndrome (CES) is a rare and serious syndrome that requires urgent surgery to improve neurological symptoms. CES can be caused by lumber disc herniation (LDH) and accounts for about 1% to 3% of all cases of disc herniation. Objectives: The purpose of this study was to analyze the characteristics and outcomes of the cases of patients with CES caused by LDH and treated by percutaneous endoscopic lumbar discectomy (PELD). Study Design: This study used a retrospective design. Setting: Research took place at the Jiangyin Hospital affiliated with Nanjing University of Chinese Medicine, Jiangsu, China. Methods: This was a retrospective study of patients treated for CES due to LDH with PELD as an emergent surgery at a single institutional department between January 2015 and March 2018. The following variables were analyzed: age, gender, the level of disc prolapse, time interval between diagnosis and surgery, lower extremity pain or weakness, perianal sensation, voluntary anal contraction, presence of bladder dysfunction, and the reversal of these deficits in follow-up. Results: After the emergent surgery with PELD, the lower extremity symptoms were all completely recovered or partly decreased. Only one patient had weakness with plantar flexion of the left foot at the one-year time point. The decreased perianal sensations were partly recovered after surgery, and 9 cases had complete recovery and 2 cases had partial recovery at the one-year follow-up. No patients had anal contraction and bladder problems after the one-year follow-up. Limitations: The number of cases reported here is limited, so we will expand the study by including an increased number of patients and a longer follow-up duration. Conclusion: Taken together, these observations show that PELD, used as a minimally invasive choice of emergent surgery, can provide enough decompression of disc prolapse and a satisfactory outcome for patients with CES caused by LDH. Key words: Cauda equina syndrome, lumbar disc herniation, outcomes, percutaneous endoscopic lumbar discectomy

Percutaneous Endoscopic Lumbar Discectomy for Treating Cauda Equina Syndrome Due To Lumbar Disc Herniation

2021 ◽  
Author(s):  
Hai-Chao He ◽  
Xiao-qiang LV ◽  
Yong-Jin Zhang
Keyword(s):  
Back Pain ◽  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background In recent decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the use of percutaneous endoscopic lumbar discectomy (PELD) to treat cauda equina syndrome (CES) due to LDH. This study aims to evaluate the feasibility and clinical efficacy of PELD for treating CES caused by disc herniation, and as well as to report some technical strategies. Methods Between October 2012 and April 2018, 15 patients with CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the subjects of study, and underwent PELD. All patients were followed up for at least two years. The patients’ back pain and leg pain were 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 and at 3 days, 3 months, 6 months and the last follow-up. Results The VAS score for back pain, leg pain and ODI score significantly decreased from preoperatively scores of 6.67 ± 1.05, 7.13 ± 1.19 and 62.0 ± 6.85 respectively, to postoperatively cores of 1.80 ± 0.41, 1.47 ± 0.52 and 12.93 ± 1.03 at the last follow-up postoperatively. These postoperative scores were all significantly different compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient with cerebrospinal fluid leakage and one patient who developed recurrent herniation; the latter patient finally achieved satisfactory results after reoperation. Conclusion PELD could be used as an alternative surgical method for the treatment of CES due to LDH in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

scholarly journals Treatment of cauda equina syndrome due to lumbar disc herniation with percutaneous endoscopic lumbar discectomy

2020 ◽  
Author(s):  
Hai-Chao He ◽  
Yong-jin Zhang
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Cauda Equina Syndrome ◽  
Lumbar Disc ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Lumbar Pain ◽  
Limb Pain ◽  
Endoscopic Lumbar Discectomy

Abstract Background: Throughout the last decades, endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. However, there is little literature on the treatment of Cauda Equina Syndrome (CES) due to lumbar disc herniation with percutaneous endoscopic lumbar discectomy (PELD). This study aims to evaluate the feasibility and clinical efficacy of PELD for CES caused by disc herniation.Methods: Between October 2012 and April 2017, 15 patients CES caused by LDH at the early and intermediate stages of Shi’s classification were selected as the objects of study, who underwent PELD. All patients were followed up for at least two years. The patients’ lumbar pain and limb pain were evaluated using visual analogue scale (VAS) scores. Patient's satisfaction was evaluated using the MacNab outcome scale. Clinical outcomes were measured preoperatively, at 3 days, 3 months, 6 month and the last follow-up.Results: The VAS score for lumbar pain was 6.67±1.05 preoperatively and 3.27±0.96, 2.73±0.46, 2.40±0.51, and 1.80±0.41, at 3 days, 3 months, 6 months and the last follow-up postoperatively respectively. The VAS score for limb pain was 7.13±1.19 preoperatively and 2.93±0.80, 2.60±0.51, 2.20±0.56, and 1.47±0.52, at 3 days, 3 months, 6 months and the last follow-up postoperatively respectively. These postoperative scores were all significantly different when compared with preoperative scores (P < 0.01). According to the modified MacNab outcome scale, excellent was obtained in 8 of 15 patients, good was obtained in 5 patients, and fair was obtained in 2 patients, and 86.67% of these patients had excellent and good outcomes at the final follow-up. Complications included one patient of cerebrospinal fluid leakage, and one patient developed recurrent herniation and who finally acquired satisfactory result after reoperation.Conclusion: PELD could be used as an alternative surgical method for the treatment of CES due to lumbar disc herniation in properly selected cases and appropriate patient selection. However, the operator should pay attention to foraminoplasty to enlarge the working space.

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 Recurrent disc herniation following percutaneous endoscopic lumbar discectomy preferentially occurs when Modic changes are present

2020 ◽  
Author(s):  
Lu Hao ◽  
Shengwen Li ◽  
Junhui Liu ◽  
Zhi Shan ◽  
Shunwu Fan ◽  
...  
Keyword(s):  
Nucleus Pulposus ◽  
Disc Herniation ◽  
Hyaline Cartilage ◽  
Modic Changes ◽  
Lumbar Discectomy ◽  
Herniated Disc ◽  
Type I ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy

Abstract Objective: To investigate the relationship between Modic changes (MCs) and recurrent lumbar disc herniation (rLDH), and that between the herniated disc component and rLDH following percutaneous endoscopic lumbar discectomy (PELD). Methods: We included 102 (65 males, 37 females, aged 20–66 yrs) inpatients who underwent PELD from August 2013 to August 2016. All patients underwent CT and MRI preoperatively. The presence and type of Modic changes were assessed. During surgery the herniated disc component of each patient was classified into two groups: nucleus pulposus group, hyaline cartilage group. The association of herniated disc component with Modic changes was investigated. The incidence of recurrent disc herniation was assessed based on more than 2-year follow-up. Results: In total, 11 patients were lost to follow up; the other 91 were followed up during 24–60 months. Of the 91 patients, 99 discs underwent PELD; 28/99 (28.3%) had MCs. Type I and II MCs were seen in 9 (9.1%) and 19 (19.2%), respectively; no type III MCs were found. Among 28 endplates with MCs, according to the herniated disc component, 18/28 (64.3%) showed evidence of hyaline cartilage in the intraoperative specimens, including 6/9 and 12/19 endplates with type I and II MCs, respectively. Among 71 endplates without MCs, 14/71 (19.7%) showed evidence of hyaline cartilage in the intraoperative specimens. Hyaline cartilage was more common in patients with MCs (P<0.05). We found 2 cases of rLDH in the non-MC group (n=71); 6 cases rLDH were found in the MC group (n=28), including 2 and 4 cases for types I and II, respectively. There was no significant difference between types I and II (P>0.05). rLDH was more common in patients with MCs (P<0.05). We found 5 rLDH cases in the hyaline cartilage group (n=32); 3 rLDH cases were found in the nucleus pulposus group (n=67). rLDH was more common in the hyaline cartilage group (P<0.05). Conclusions: MCs were associated with the herniated cartilage disc component. rLDH following PELD preferentially occurs when MCs or the herniated cartilage are present. Patients with MCs following PELD might require a second operation.

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 Percutaneous Endoscopic Lumbar Discectomy for a Huge Herniated Disc Causing Acute Cauda Equina Syndrome: A Case Report

2015 ◽  
Vol 62 (1.2) ◽  
pp. 100-102 ◽  
Author(s):  
Subash C. Jha ◽  
Ichiro Tonogai ◽  
Yoichiro Takata ◽  
Toshinori Sakai ◽  
Kosaku Higashino ◽  
...  
Keyword(s):  
Case Report ◽  
Cauda Equina Syndrome ◽  
Cauda Equina ◽  
Lumbar Discectomy ◽  
Herniated Disc ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy

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 Clinical Application of Transforaminal Percutaneous Endoscopic Lumbar Discectomy Via Superior Notch of Inferior Vertebral Pedicle Approach for Very High-grade Inferiorly Migrated Disc Herniation

2020 ◽  
Author(s):  
Song Chen ◽  
Jinghuai Wang ◽  
Shiqi Suo ◽  
Yunxia Wang ◽  
Chengli Li ◽  
...  
Keyword(s):  
Clinical Application ◽  
Disc Herniation ◽  
Lumbar Discectomy ◽  
Leg Pain ◽  
High Grade ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
The Mean ◽  
Endoscopic Lumbar Discectomy ◽  
Very High

Abstract Background: To assess the efficacy of the superior notch of inferior vertebral pedicle approach of transforaminal percutaneous endoscopic lumbar discectomy for very high-grade inferiorly migrated disc herniation.Methods: Data on 32 consecutive patients operated with percutaneous endoscopic surgery via the superior notch of inferior vertebral pedicle approach were reviewed. Age, gender, clinical diagnoses, operation time, hospitalization time, a self-administered questionnaire composed of the leg pain visual analogue scale (VAS leg pain) and the Oswestry Disability Index (ODI) had been recorded before operation and 1, 3, 6 and 12 months after operation, respectively. The clinical results were assessed at the final follow-up by using modified Macnab criteria. Complications were recorded during follow-up, and postoperative X-ray, CT and MRI examinations were performed.Results: There were 21 males and 11 females. The mean age of patients was 51.8±10.6 years. MRI findings of patients with disc herniation were L2-3 level in 4 case, L3-4 level in 9 cases and L4-5 level in 19 cases, which were correlated with clinical symptoms. All patients completed a 12-month follow-up assessment after surgery. The mean operative duration was 68.2±12.8 min, and hospitalization time was 3.6±0.8 days. At 12 months follow up the VAS leg pain had improved by 6.3 (P< 0.05) and the ODI by 43.6 points (P< 0.05). Twenty-three cases (71.9%) were rated as excellent, 7 (21.9%) as good, 2 (6.2%) as fair at the final follow-up. On the basis of the modified MacNab criteria, the overall excellent and good rate was 93.8%. Two patients (6.2%) had transient dysesthesia after surgery. Postoperative radiological evaluations showed no signs of instability or recurrence of pathology.Conclusion: Transforaminal percutaneous endoscopic lumbar discectomy via the superior notch of inferior vertebral pedicle approach could be a safe and effective minimally invasive technique for very high-grade inferiorly migrated disc herniation. This technique warrants further study and clinical application.

scholarly journals Surgical Outcome of Two-Level Transforaminal Percutaneous Endoscopic Lumbar Discectomy for Far-Migrated Disc Herniation

2016 ◽  
Vol 2016 ◽  
pp. 1-6 ◽  
Author(s):  
Xinbo Wu ◽  
Guoxin Fan ◽  
Xin Gu ◽  
Xiaofei Guan ◽  
Shisheng He
Keyword(s):  
Conservative Treatment ◽  
Disc Herniation ◽  
Lumbar Disc ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Transforaminal Approach ◽  
Recurrent Herniation ◽  
The Mean ◽  
Endoscopic Lumbar Discectomy

Objective.To describe the two-level percutaneous endoscopic lumbar discectomy (PELD) technique in transforaminal approach for highly migrated disc herniation and investigate its clinical outcomes.Methods.A total of 22 consecutive patients with highly migrated lumbar disc herniation were enrolled for the study from June 2012 to February 2014.Results.There were 12 males and 10 females, with a mean age of 41.1 (range 23–67) years. The mean follow-up period was 18.05 (range 14–33) months. According to the modified MacNab criteria, the clinical outcome at the final follow-up was excellent in 14, good in 6, and fair in 2 patients and the satisfactory rate (excellent and good) was 90.9%. The improvements in VAS and ODI were statistically significant. One patient had recurrent herniation in 18 months after the first surgery and underwent open discectomy. One patient showed symptoms of postoperative dysesthesia (POD), but the POD symptom was transient and partial remission was achieved in two months after conservative treatment.Conclusion.Two-level PELD in transforaminal approach can be a safe and effective procedure for highly migrated disc herniation.

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