scholarly journals Pain Variability of Tissues Under Endoscope in Percutaneous Endoscopic Lumbar Discectomy and Its Significance: A Retrospective Study

2021 ◽  
Vol 24 (6) ◽  
pp. E877-E882
Keyword(s):  
Nerve Root ◽  
Annulus Fibrosus ◽  
Ligamentum Flavum ◽  
Lumbar Disc ◽  
Posterior Longitudinal Ligament ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Dural Sac ◽  
Vas Scores ◽  
Endoscopic Lumbar Discectomy

BACKGROUND: Percutaneous endoscopic lumbar discectomy (PELD), as a representative minimally invasive spine surgery technique for lumbar disc herniation (LDH), has been standardized. In PELD, tissues such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate were exposed, removed, and decompressed. However, during PELD, whether there is pain or not in the tissues under endoscope in LDH patients has never been thoroughly discussed in the previous research. OBJECTIVES: The purpose of the study is to evaluate tissue pain variability during PELD as for the treatment of LDH, to provide references and guideline for the operation, and to give humanistic care for patients. STUDY DESIGN: A retrospective analysis. SETTING: All data were collected from Shandong Provincial Hospital Affiliated to Shandong First Medical University. METHODS: From January 2008 to December 2020, 3,600 patients with LDH were enrolled in this retrospective study. All patients suffered from low back and leg pain because of LDH and underwent PELD. The pain of these tissues under endoscope was assessed according to the Visual Analog Scale (VAS) scores for the back and legs (VAS-B and VAS-L, respectively). RESULTS: For VAS-B, the tissues were ranked from the highest VAS scores to the lowest in the following order: posterior longitudinal ligament; next, dural sac/nerve root; then, endplate/annulus fibrosus/ligamentum flavum. For VAS-L, they were in the following order: dural sac/nerve root; next, posterior longitudinal ligament; then, endplate/annulus fibrosus/ligamentum flavum. LIMITATIONS: Retrospective nature of data collection. CONCLUSIONS: Tissues, such as ligamentum flavum, dural sac, nerve root, posterior longitudinal ligament, annulus fibrosus, and endplate, have different kinds of pain in PELD for LDH. KEY WORDS: Percutaneous endoscopic lumbar discectomy, visual analog scale, lumbar disc herniation, pain

Risk of reoperation and infection after percutaneous endoscopic lumbar discectomy and open lumbar discectomy

2021 ◽  
Vol 103-B (8) ◽  
pp. 1392-1399
Author(s):  
Tae Wook Kang ◽  
Si Young Park ◽  
Hoonji Oh ◽  
Soon Hyuck Lee ◽  
Jong Hoon Park ◽  
...  
Keyword(s):  
Lumbar Disc ◽  
Surgical Techniques ◽  
Lumbar Discectomy ◽  
Infection Rates ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Primary Endpoints ◽  
Registration Number ◽  
History Of ◽  
Endoscopic Lumbar Discectomy ◽  
Reoperation Rates

Aims Open discectomy (OD) is the standard operation for lumbar disc herniation (LDH). Percutaneous endoscopic lumbar discectomy (PELD), however, has shown similar outcomes to OD and there is increasing interest in this procedure. However despite improved surgical techniques and instrumentation, reoperation and infection rates continue and are reported to be between 6% and 24% and 0.7% and 16%, respectively. The objective of this study was to compare the rate of reoperation and infection within six months of patients being treated for LDH either by OD or PELD. Methods In this retrospective, nationwide cohort study, the Korean National Health Insurance database from 1 January 2007 to 31 December 2018 was reviewed. Data were extracted for patients who underwent OD or PELD for LDH without a history of having undergone either procedure during the preceding year. Individual patients were followed for six months through their encrypted unique resident registration number. The primary endpoints were rates of reoperation and infection during the follow-up period. Other risk factors for reoperation and infection were also evalulated. Results Out of 549,531 patients, 522,640 had undergone OD (95.11%) and 26,891 patients had undergone PELD (4.89%). Reoperation rates within six months were 2.28% in the OD group, and 5.38% in the PELD group. Infection rates were 1.18% in OD group and 0.83% in PELD group. The risk of reoperation was lower for patients with OD than for patients with PELD (adjusted hazard ratio (HR) 0.38). The risk of infection was higher for patients with OD than for patients undergoing PELD (HR, 1.325). Conclusion Compared with the OD group, the PELD group showed higher reoperation rates and lower infection rates. Cite this article: Bone Joint J 2021;103-B(8):1392–1399.

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.

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