scholarly journals Lower Learning Difficulty and Fluoroscopy Reduction of Transforaminal Percutaneous Endoscopic Lumbar Discectomy with an Accurate Preoperative Location Method

2016 ◽  
Vol 8;19 (8;11) ◽  
pp. E1123-E1134
Author(s):  
Shisheng He
Keyword(s):  
Operation Time ◽  
Lumbar Discectomy ◽  
Learning Difficulty ◽  
Location Method ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy ◽  
The Impact ◽  
Fluoroscopy Reduction

Background: Transforaminal percutaneous endoscopic lumbar discectomy (tPELD) poses great challenges for junior surgeons. Beginners often require repeated attempts using fluoroscopy causing more punctures, which may significantly undermine their confidence and increase the radiation exposure to medical staff and patients. Moreover, the impact of an accurate location on the learning curve of tPELD has not been defined. Objective: The study aimed to investigate the impact of an accurate preoperative location method on learning difficulty and fluoroscopy time of tPELD. Study Design: Retrospective evaluation. Setting: Patients receiving tPELD by one surgeon with a novel accurate preoperative location method were regarded as Group A, and those receiving tPELD by another surgeon with a conventional fluoroscopy method were regarded as Group B. Methods: From January 2012 to August 2014, we retrospectively reviewed the first 80 tPELD cases conducted by 2 junior surgeons. The operation time, fluoroscopy times, preoperative location time, and puncture-channel time were thoroughly analyzed. Results: The operation time of the first 20 patients were 99.75 ± 10.38 minutes in Group A and 115.7 ± 16.46 minutes in Group B, while the operation time of all 80 patients was 88.36 ± 11.56 minutes in Group A and 98.26 ± 14.90 minutes in Group B. Significant differences were detected in operation time between the 2 groups, both for the first 20 patients and total 80 patients (P < 0.05). The fluoroscopy times were 26.78 ± 4.17 in Group A and 33.98 ± 2.69 in Group B (P < 0.001). The preoperative location time was 3.43 ± 0.61 minutes in Group A and 5.59 ± 1.46 minutes in Group B (P < 0.001). The puncture-channel time was 27.20 ± 4.49 minutes in Group A and 34.64 ± 8.35 minutes in Group B (P < 0.001). There was a moderate correlation between preoperative location time and puncture-channel time (r = 0.408, P < 0.001), and a moderate correlation between preoperative location time and fluoroscopy times (r = 0.441, P < 0.001). Mild correlations were also observed between preoperative location time and operation time (r = 0.270, P = 0.001). There were no significant differences in preoperative back visual analogue scale (VAS) score, postoperative back VAS, preoperative leg VAS, postoperative leg VAS, preoperative Japanese Orthopaedic Association (JOA) score, postoperative JOA, preoperative Oswestry disability score (ODI), or postoperative ODI (P > 0.05). However, significant differences were all detected between preoperative abovementioned scores and postoperative scores (P < 0.05). Moreover, there was no significant differences in Macnab satisfaction between the 2 groups (P = 0.179). There were 2 patients with recurrence in Group A and 3 patients in Group B. Twelve patients with postoperative disc remnants were identified in Group A and 9 patients in Group B. No significant difference was identified between the 2 groups (P = 0.718). Limitations: The preoperative lumbar location method is just a tiny step in tPELD, junior surgeons still need to focus on their subjective feelings during punctures and accumulating their experienceConclusions: The accurate preoperative location method lowered the learning difficulty and reduced the fluoroscopy time of tPELD, which was also associated with lower preoperative location time and puncture-channel time. Key words: Learning difficulty, fluoroscopy reduction, transforamimal percutaneous endoscopic lumbar discectomy, preoperative location in endoscopic discectomy

scholarly journals Percutaneous Endoscopic Lumbar Discectomy Assisted by O-Arm-Based Navigation Improves the Learning Curve

2019 ◽  
Vol 2019 ◽  
pp. 1-9 ◽  
Author(s):  
Shengxiang Ao ◽  
Junlong Wu ◽  
Yu Tang ◽  
Chao Zhang ◽  
Jie Li ◽  
...  
Keyword(s):  
Learning Curve ◽  
Radiation Exposure ◽  
Disc Herniation ◽  
Operation Time ◽  
Lumbar Discectomy ◽  
Low Back ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy ◽  
Cannula Placement

Objective. There is a steep learning curve with traditional percutaneous endoscopic lumbar discectomy (PELD). The aim of this study is to assess the safety and efficacy of PELD assisted by O-arm-based navigation for treating lumbar disc herniation (LDH).Methods. From September of 2017 to January of 2018, 118 patients with symptomatic LDH were enrolled in the prospective cohort study. The patients undergoing PELD with O-arm-based navigation technique were defined as group A (58 cases), and those undergoing traditional X-ray fluoroscopy method were defined as group B (60 cases). We recorded the operation time, cannula placement time, radiation exposure time, visual analog scale (VAS), Oswestry Disability Index (ODI), and Macnab criteria score of the 2 groups.Results. The average operation time (95.21 ± 19.05 mins) and the cannula placement time (36.38 ± 14.67 mins) in group A were significantly reduced compared with group B (operation time, 113.83 ± 22.01 mins, P<0.001; cannula placement time, 52.63 ± 17.94 mins, P<0.001). The learning curve of PELD in group A was steeper than that in group B and was lower in the relatively flat region of the end. There were significant differences of the clinical parameters at different time points (VAS of low back, P < 0.001; VAS of leg, P < 0.001; and ODI, P < 0.001). The VAS scores for low back pain and leg pain improved significantly in both groups after surgery and gradually improved as time went by. No serious complication was observed in any patients in either group.Conclusion. The study indicated that PELD assisted by O-arm navigation is safe, accurate, and efficient for the treatment of lumbar intervertebral disc herniation. It reshaped the learning curve of PELD, reduced the difficulty of surgery, and minimized radiation exposure to surgeons. This study was registered at Chinese Clinical Trail Registry (Registration Number:ChiCTR1800019586).

scholarly journals Effect of Dexmedetomidine Administation on Analgesic, Respiration and Inflammatory Responses in Patients Undergoing Percutaneous Endoscopic Lumbar Discectomy: A Prospective Observational Study

2021 ◽  
Author(s):  
Xiaoli Zhang ◽  
Wenping Zhao ◽  
Cong Sun ◽  
Zhihua Huang ◽  
Lifang Zhan ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Serum Levels ◽  
Lumbar Discectomy ◽  
Lower Serum ◽  
Inflammatory Reactions ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Tnf Α ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Abstract BackgroundLocal anesthesia has been recommended for percutaneous endoscopic lumbar discectomy (PELD) in recent years; however, the efficacy, including oxidative stress, inflammatory reactions and ventilation effects, when intravenous dexmedetomidine (DEX) is administered during PELD has not been thoroughly described.MethodsSixty patients undergoing PELD were randomly allocated to either an intravenous DEX sedation group (Group A) or a normal saline group (Group B). Respiratory data, including minute ventilation (MV), tidal volume (TV), and respiratory rate (RR), were recorded using a respiratory volume monitor (RVM), and pulse oxygen saturation (SpO2) was measured by pulse oximetry. The visual analog score (VAS) and the plasma levels of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), malondialdehyde (MDA) and glutathione peroxidase (GSH-PX) were also recorded to evaluate oxidative stress and inflammatory reactions.ResultsThere were no significant differences in RR, MV, TV and SpO2 between the two groups at any time point (p>0.05). Group B exhibited lower serum levels of GSH-PX (p<0.0001) and higher serum levels of MDA (p<0.0001) than Group A at the end of surgery. Twenty-four hours after surgery, Group B exhibited higher serum levels of IL-6 (p=0.0033), TNF-α(p=0.0002), and MDA (p<0.0001) and lower serum levels of GSH-PX (p<0.0001) than Group A. In addition, Group B exhibited lower VAS (p<0.0001) than Group A.ConclusionsDEX administration using an RVM not only provides convenient analgesia and ventilation but also alleviates oxidative stress and inflammatory reactions in patients undergoing PELD .Trial registration ChiCTR2100044715(http://www.chictr.org.cn/index.aspx)

scholarly journals Foraminoplasty at the Tip or Base of the Superior Articular Process for Lateral Recess Stenosis in Percutaneous Endoscopic Lumbar Discectomy: A Multicenter, Retrospective, Controlled Study with 2-Year Follow-Up

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Jun-Song Yang ◽  
Lei Chu ◽  
Chien-Min Chen ◽  
Xiang-Fu Wang ◽  
Pei-Gen Xie ◽  
...  
Keyword(s):  
Clinical Efficacy ◽  
Lumbar Discectomy ◽  
Lateral Recess ◽  
Articular Process ◽  
Lateral Recess Stenosis ◽  
Sf 36 ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Objective. To compare the clinical efficacy and complications which obtained foraminoplasty at the tip or base of the superior articular process (SAP) for the patients with lateral recess stenosis treated by percutaneous endoscopic lumbar discectomy (PELD). Methods. Between January 2015 and January 2016, 156 patients of lumbar disc herniation accompanying with lateral recess stenosis were treated with PELD in five tertiary hospitals and fulfilled the 2-year follow-up. Among them, 78 patients obtained a foraminoplasty at the tip of SAP (group A), and foraminoplasty at the base of SAP was performed in the other 78 cases (group B). Clinical efficacy was evaluated using the visual analog scale (VAS) score for back and leg pain, Oswestry Disability Index (ODI), and 36-item Short-Form Health Survey (SF-36) score. The intervals of follow-up were scheduled at 1 month, 3 months, 6 months, 1 year, and 2 years after surgery. Results. Mean operative duration is shorter in group B (55 versus 61 min, P = 0.047). Only one case belonged to group A could not tolerate the neural irritation and required conversion to an open procedure. During the surgery, no dura tears, cauda equina syndrome, or infections were observed. 5 patients experienced transient dysesthesia located at the exiting nerve in group A, while no cases complained dysesthesia in group B. 2 cases who suffered temporary motor weakness all belonged to group A. A total of 5 cases obtained a revision surgery after recurrence in the follow-up, in which 3 patients belonged to group A. Compared to the preoperative data, significant improvements in VAS scores of low back pain and sciatica, ODI, and SF-36 PCS and MC were observed in the follow-up, respectively (P < 0.05, respectively). However, no statistical difference was observed at all time-points after surgery between these two groups (P > 0.05, respectively). Conclusions. For the patients of LDH accompanying with lateral recess stenosis, compared with the routine foraminoplasty at the tip of SAP, our modified foraminoplastic technique does not only change place of foraminoplasty to the base of SAP but also simplified puncture process in transforaminal PELD. Although there was no significant difference in symptom relief, the modified foraminoplasty showed the advantages in decreasing the incidence of postoperative neural dysfunction and reducing operation time.

scholarly journals Estimation and influence of blood loss under endoscope for percutaneous endoscopic lumbar discectomy (PELD): a clinical observational study combined with in-vitro experiment

2020 ◽  
Author(s):  
DongDong Sun ◽  
Dan Lv ◽  
Wei Zhou Wu ◽  
HeFei Ren ◽  
BuHe Bao ◽  
...  
Keyword(s):  
Blood Loss ◽  
Clinical Research ◽  
Operation Time ◽  
Vitro Experiment ◽  
In Vitro Experiment ◽  
Estimated Blood Loss ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy

Abstract Purpose: The purpose of this study is to come up with new methods to quantitate the blood loss under endoscope and explore the influence of blood loss on percutaneous endoscopic lumbar discectomy (PELD). Methods: Clinical research and in-vitro experiment are combined. In the in-vitro experiment, 2.0 ml blood was diluted in different ratio to simulate the rinse solution of PELD, the hematocrit method (HCT-M) and red blood cell count method (RBC-M) were came up to estimate blood loss and the new methods were calibrated with the directly measurement method (Direct-M). In clinical research, 74 patients with L5/S1 disc herniation were treated with PELD, HCT-M and the empirical method (EMP-M) were used to estimate the blood loss under endoscope. According to blood loss, all patients were divided into group A (≤10 ml) and group B (>10 ml). The blood loss, operation time, fluoroscopy frequency, visual analog scale (VAS) and oswestry disability index (ODI) scores were compared between the two groups. Results: In the in-vitro experiment, the hematocrit of the rinse solution was always stable over time. The estimated blood loss by HCT-M was stable and quite approximate to actual blood volume (2.0 ml) whatever the blood dilution ratio, while according to RBC-M, the estimated blood loss was close to the actual blood volume only when the dilution ratio was greater than 300 times. In clinical research, the blood loss estimated by HCT-M was higher than that by EMP-M in both groups (P<0.05). There was a significant difference between group A and group B in blood loss (7.40±1.61 vs 19.91±10.94 ml), operation time (80.51±34.70 vs 136.51±41.88 min), and fluoroscopy frequency (6.92±1.52 vs 11.11±2.32 times) (P<0.05). The VAS and ODI scores in group B were higher than that in group A 1 week after operation (P<0.05), however the scores were not different between the two groups at pre-operation (P>0.05). Conclusion: HCT-M is a reliable method to estimate endoscopic blood loss in PELD. The amount of endoscopic blood loss affects the operative procedure in operation time and fluoroscopy frequency, as well as clinical effects in VAS and ODI scores after operation in short-term

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 comparison between remaining and resecting the posterior longitudinal ligament in percutaneous endoscopic transforaminal discectomy for disc herniation: A retrospective cohort study

2020 ◽  
Author(s):  
Wenhao Hu ◽  
Fanqi Hu ◽  
Chao Liu ◽  
Weibo Liu ◽  
Yi Jiang ◽  
...  
Keyword(s):  
Accurate Determination ◽  
Operation Time ◽  
Posterior Longitudinal Ligament ◽  
Surgical Methods ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Endoscopic Lumbar Discectomy ◽  
Surgical Duration

Abstract Background Nowadays, percutaneous endoscopic lumbar discectomy (PELD) has become a popular surgical option for the management of LDH, On the basis of the approach to the herniation disc materials, PELD could be classified into percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). During PETD procedure, especially in in-and-out approach, accurate determination of whether the posterior longitudinal ligament is needed resection seems particularly important.In the study, we tried assessing comparative clinical outcome, surgical duration and complications between the two different surgical methods of LDH treated by PETD via inside-and-out approach. Methods A total of 135 symptomatic LDH patients who were treated by PETD resecting the posterior longitudinal ligament (68 patients) or remaining the posterior longitudinal ligament (67 patients) during the surgery were included in the study. Visual analog scale (VAS) score, Oswestry disability index (ODI) and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH and other complication such as dural tear, nerve injury, intervertebral infection, etc. of these two groups were recorded. Clinical evaluation was performed preoperatively, immediately postoperatively, and at each follow-up visit (1 month, 3 months, and final follow-up). Results There were 38 males and 30 females in the group A that resecting the posterior longitudinal ligament (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the group B that remaining the posterior longitudinal ligament (mean age = 53.50 ± 9.24 years). The mean operation time of the group A and the group B respectively, were 82.7 ± 18.5 min and 115.6 ± 24.6 min (P < 0.01). The postoperative VAS scores and ODI were significantly higher than those before surgery in two groups (P < 0.01). The differences in the results were not significant between the two groups (P > 0.05). There was no significant difference in the complication rate, the excellent/good ratio and the recurrence rate between the two groups (P > 0.05). Conclusion Whether the posterior longitudinal ligament is resected do not make any difference on curative effect in PETD via inside-and-out approach, and remaining the ligament when it’s intact is preferred because of its shorter operation time.

scholarly journals Clinical efficacy of percutaneous endoscopic lumbar discectomy for the treatment of lumbar spinal stenosis in elderly patients

2020 ◽  
Author(s):  
hua Li ◽  
Yufu Ou ◽  
Furong Xie ◽  
Weiguo Liang ◽  
Gang Tian ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Clinical Efficacy ◽  
Japanese Orthopaedic Association ◽  
Operation Time ◽  
Lumbar Discectomy ◽  
Percutaneous Endoscopic Lumbar Discectomy ◽  
Endoscopic Lumbar Discectomy ◽  
Lumbar Spinal

Abstract Background: Although: percutaneous endoscopic lumbar discectomy (PELD) is increasingly being used to treat lumbar degenerative disease, the treatment of elderly patients with lumbar spinal stenosis (LSS) involves considerable uncertainty. The purpose of this study was to evaluate the safety and effectiveness of PELD for the treatment of LSS in elderly patients aged 65 years or older. Methods: In this retrospective review, 136 patients aged 65 years or older who underwent PELD to treat LSS were evaluated. The patients were divided into two groups, group A (age 65-74) and group B (age ≥ 75), and perioperative data were analyzed. The Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and MacNab classification were used to evaluate postoperative clinical efficacy. Results: All patients successfully underwent the operation with satisfactory treatment outcomes. Compared to preoperative scores, the self-reported scores or pain while performing daily activities were significantly improved in both treatment groups (P<0.05). No statistically significant between-group differences were observed in operation time.

scholarly journals The Impact of Left Atrial Size in Catheter Ablation of Atrial Fibrillation Using Remote Magnetic Navigation

2018 ◽  
Vol 2018 ◽  
pp. 1-8
Author(s):  
Xiao-yu Liu ◽  
Hai-feng Shi ◽  
Jie Zheng ◽  
Ku-lin Li ◽  
Xiao-xi Zhao ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Left Atrial ◽  
Magnetic Navigation ◽  
Remote Magnetic Navigation ◽  
X Ray ◽  
Group A ◽  
Group B ◽  
The Impact

Objective. The objective of this study was to investigate the impact of left atrial (LA) size for the ablation of atrial fibrillation (AF) using remote magnetic navigation (RMN). Methods. A total of 165 patients with AF who underwent catheter ablation using RMN were included. The patients were divided into two groups based on LA diameter. Eighty-three patients had small LA (diameter <40 mm; Group A), and 82 patients had a large LA (diameter ≥40 mm; Group B). Results. During mapping and ablation, X-ray time (37.0 (99.0) s vs. 12 (30.1) s, P<0.001) and X-ray dose (1.4 (2.7) gy·cm2 vs. 0.7 (2.1) gy·cm2, P=0.013) were significantly higher in Group A. No serious complications occurred in any of the patients. There was no statistical difference in the rate of first anatomical attempt of pulmonary vein isolation between the two groups (71.1% vs. 57.3%, P=0.065). However, compared with Group B, the rate of sinus rhythm was higher (77.1% vs. 58.5%, P<0.001) during the follow-up period. More patients in Group A required a sheath adjustment (47/83 vs. 21/82, P<0.001), presumably due to less magnets positioned outside of the sheath. In vitro experiments with the RMN catheter demonstrated that only one magnet exposed created the sheath affects which influenced the flexibility of the catheter. Conclusions. AF ablation using RMN is safe and effective in both small and large LA patients. Patients with small LA may pose a greater difficulty when using RMN which may be attributed to the fewer magnets beyond the sheath. As a result, the exposure of radiation was increased. This study found that having at least two magnets of the catheter positioned outside of the sheath can ensure an appropriate flexibility of the catheter.

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