Clinical Outcome of Fenestration as Minimally Invasive Surgery for Lumbar Disc Herniation: Successes and Obstacles

Abstract Background: Calcified lumbar disc herniation (CLDH) is considered to be a special type of lumbar disc herniation (LDH). Percutaneous endoscopic interlaminar discectomy (PEID), with safety and efficacy, has been proved to be a minimally invasive surgery for LDH. However, there are few studies on PEID in the treatment of CLDH at L5-S1 level. This research aimed to analyze the clinical efficacy of PEID for L5-S1 CLDH.Methods: From August 2016 to April 2020, we retrospectively analyzed 28 consecutive patients (17 males; 11 females) with L5-S1 CLDH treated with PEID at our institution. All the patients were followed up for greater than 1 year postoperatively. The demographic characteristics, surgical results and clinical outcomes estimated by the visual analog scale (VAS) for leg pain, Oswestry disability index (ODI) and modified MacNab criteria were collected.Results: All patients were successfully performed by PEID. The mean operative time and intraoperative blood loss were 65.36 ± 5.26 minutes and 13.21 ± 4.35 ml, respectively. The VAS for leg pain and ODI scores improved remarkably from 7.54 ± 0.96 to 1.50 ± 0.51 (P < 0.05) and from 69.29 ± 9.91 to 17.43 ± 3.69 (P < 0.05) a year after operation, respectively. According to the modified MacNab criteria of the last follow-up, the excellent and good rates are 92.86%. Two of the patients had complications, one had nerve root injury and the other had postoperative dysesthesia.Conclusions: PEID achieved good clinical outcomes in the treatment of L5-S1 CLDH. And PEID was a safe and effective minimally invasive surgery for L5-S1 CLDH.

Download Full-text

Minimally Invasive Surgery with Spotlight Work Channel System in the Treatment of Lumbar Disc Herniation: A Retrospective Study of 21 Cases

Cell Biochemistry and Biophysics ◽

10.1007/s12013-014-0190-3 ◽

2014 ◽

Vol 71 (1) ◽

pp. 243-248 ◽

Cited By ~ 1

Author(s):

Haidong Xu ◽

Fengyu Jia ◽

Yanbin Liu ◽

Qiang Fu

Keyword(s):

Minimally Invasive Surgery ◽

Retrospective Study ◽

Minimally Invasive ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Invasive Surgery ◽

Lumbar Disc ◽

Channel System

Download Full-text

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Journal of Neurosurgery Spine ◽

10.3171/2015.4.spine14883 ◽

2016 ◽

Vol 24 (1) ◽

pp. 48-53 ◽

Cited By ~ 10

Author(s):

Ulrich Hubbe ◽

Pamela Franco-Jimenez ◽

Jan-Helge Klingler ◽

Ioannis Vasilikos ◽

Christoph Scholz ◽

...

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operating Time ◽

Leg Pain ◽

P Value ◽

Vas Scores ◽

Recurrent Lumbar Disc Herniation

OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

Download Full-text

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

10.21203/rs.3.rs-35673/v1 ◽

2020 ◽

Author(s):

Seong Son ◽

Chan Jong Yoo ◽

Byung Rhae Yoo ◽

Woo Seok Kim ◽

Tae Seok Jeong

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Learning Curve ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Early Group ◽

Significant Difference ◽

Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation. However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve. Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

Download Full-text

Learning curve of trans-sacral epiduroscopic laser decompression in herniated lumbar disc disease

10.21203/rs.3.rs-35673/v3 ◽

2020 ◽

Author(s):

Seong Son ◽

Chan Jong Yoo ◽

Byung Rhae Yoo ◽

Woo Seok Kim ◽

Tae Seok Jeong

Keyword(s):

Clinical Outcome ◽

Minimally Invasive ◽

Learning Curve ◽

Lumbar Disc Herniation ◽

Disc Herniation ◽

Lumbar Disc ◽

Operation Time ◽

Early Group ◽

Significant Difference ◽

Late Group

Abstract Background: Trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscope and a holmium YAG laser is one of the minimally invasive surgical options for lumbar disc herniation.However, the learning curve of SELD and the effect of surgical proficiency on clinical outcome have not yet been established. We investigated patients with lumbar disc herniation undergoing SELD to report the clinical outcome and learning curve.Methods: Retrospective analysis of clinical outcome and learning curve were performed at a single center from clinical data collected from November 2015 to November 2018. A total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. Based on the findings that the cut-off of familiarity was 20 cases according to the cumulative study of operation time, patients were allocated to two groups: early group (n = 20) and late group (n = 62). The surgical, clinical, and radiological outcomes were retrospectively evaluated between the two groups to analyze the learning curve of SELD.Results: According to linear and log regression analyses, the operation time was obtained by the formula: operation time = 58.825 - (0.181 × [case number]) (p < 0.001). The mean operation time was significantly different between the two groups (mean 56.95 minutes; 95% confidence interval [CI], 49.12–64.78 in the early group versus mean 45.34 minutes; 95% CI, 42.45–48.22 in the late group; p = 0.008, non-parametric Mann-Whitney U test).Baseline characteristics, including demographic data, clinical factors, and findings of preoperative magnetic resonance imaging, did not differ between the two groups. Also, there was no significant difference in terms of surgical outcomes, including complication and failure rates, as well as clinical and radiological outcomes between the two groups.Conclusion: The learning curve of SELD was not as steep as that of other minimally invasive spinal surgery techniques, and the experience of surgery was not an influencing factor for outcome variation.

Download Full-text

Minimally invasive decompression for lumbar stenosis and disc herniation

Neurosurgical FOCUS ◽

10.3171/foc/2008/25/8/e11 ◽

2008 ◽

Vol 25 (2) ◽

pp. E11 ◽

Cited By ~ 29

Author(s):

Sean S. Armin ◽

Langston T. Holly ◽

Larry T. Khoo

Keyword(s):

Minimally Invasive Surgery ◽

Minimally Invasive ◽

Disc Herniation ◽

Invasive Surgery ◽

Lumbar Disc ◽

Invasive Technique ◽

Lumbar Stenosis ◽

New Techniques ◽

Pathological Conditions ◽

Minimally Invasive Decompression

For decades, lumbar disc herniation and lumbar stenosis have been treated surgically via traditional open techniques. With recent emphasis on minimally invasive approaches in spine surgery, a number of new techniques has been introduced that are aimed at treating these 2 common pathological conditions. Currently the most widely used and efficacious minimally invasive technique for treating these disorders is direct decompression with minimally invasive surgery. Due to the scarcity of large randomized studies, however, it is difficult to compare the effectiveness and possible superiority of this technique with traditional decompression. Further studies are needed to evaluate this issue.

Download Full-text