A one-step foraminoplasty via a large trephine in percutaneous endoscopic transforaminal discectomy for the treatment of lumbar disc herniation

Abstract

Background Transforaminal percutaneous endoscopic lumbar discectomy (PELD) is a widely used basic technique for lumbar disc herniation (LDH) with advantages including causing less trauma and fast recovery. The secure, efficient, and rapid enlargement of the intervertebral foramen is a key step in PELD procedures. However, the conventional multi-step trephine system for foraminoplasty involves complicated surgical procedures. In this study, we reported an improved one-step foraminoplasty via a large trephine with simplified surgical procedures, reduced radiation exposure, and shortened operative time. Methods 70 LDH patients who underwent PELD were retrospectively reviewed in this study. The conventional multi-step trephine system was used for foraminoplasty in 35 patients in the multi-step (MS) group, and the single large trephine was used in the other 35 patients in the one-step (OS) group. Indicators including the operative time, the time to establish the working cannula, intraoperative fluoroscopy times, the radiation dose, and postoperative complications were compared between the MS and OS group. Results The operative time and the time to establish the working cannula in the OS group was significantly shorter than that in the MS group (P < 0.01); intraoperative fluoroscopy times and the radiation dose in the OS group were significantly smaller than those in the MS group (P < 0.01). There was no statistical difference in the incidence of postoperative complications between the two groups (P > 0.05). The postoperative VAS scores and ODI scores (2 days and 3 months after the surgery) were significantly lower than the preoperative scores in both groups (P < 0.01), and there was no statistical difference in VAS scores or ODI scores between the two groups at the same time points (P > 0.05). Conclusions The one-step foraminoplasty via a single large trephine is an optimized technique evolving from the conventional multi-step foraminoplasty, showing significant superiority in simplified operation, shorted operative time, and reduced radiation exposure.

Research Trends of Percutaneous Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation Over the Past Decade: A Bibliometric Analysis

“…3 PELD, a minimally invasive spine surgery, has been a mainstream technique for lumbar disc herniation. 4 Some studies suggested a similar incidence of recurrence between PELD and open discectomy or microendoscopic discectomy (MED). [5][6][7] But others reported that PELD had a higher reoperation rate than open surgery.…”

Comparison of bone reamer and trephine for foraminoplasty in percutaneous endoscopic lumbar discectomy based on 3D slicer and Digimizer software

“…Two mainly used tools to perform foraminoplasty including a uoroscopy-guided bone reamer or trephine have mainly described in previous studies. Bone reamer is less likely to destabilize the facet joint and cause the neural injury [3] , but the time-demanding procedure increases the risk of radiation exposure [4] ; Trephine is more e cient [5] and less radiation exposure [6] , but it tends to excise too much bone around the intervertebral foramen [7] , increasing the risk of lumbar instability and neural injury [8] . Therefore, it is important to nd a balance between the dose of X-ray exposure and the amount of bone resection while ensuring the effectiveness of foraminoplasty.…”