A preliminary study on surgical navigation for epiduroscopic laser neural decompression

Jeon, Sangseo; Lee, Gun Woo; Jeon, Young Dae; Park, Il-Hyung; Hong, Jin; Kim, Jae-Do

doi:10.1177/0954411915599801

Cited by 11 publications

(4 citation statements)

References 45 publications

(43 reference statements)

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“…According to previous studies, the clinical or surgical outcomes of SELD were found to be favorable in various lumbar spine diseases [3][4][5][6][7][12][13][14][15][16][17]. In particular, several recent papers regarding the clinical outcome of SELD for disc herniation have reported that the clinical outcome was favorable as there was signi cant improvement in low back pain or radiating leg pain, patient satisfaction rate of more than 70%, and low rates of surgical failure or recurrence [8,[18][19][20][21].…”

Section: Discussionmentioning

confidence: 99%

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

Son

Yoo

et al. 2020

Preprint

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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.

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Section: Discussionmentioning

confidence: 99%

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

Son

Yoo

et al. 2020

Preprint

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“…Since 2000s, in the early days of SELD, some reports have suggested its clinical application in various lumbar spinal diseases to not only disc herniation but also adhesion or fibrosis around nerve roots, failed back surgery, and even spinal stenosis [6][7][8][9][10][11][12][13][14][15]. Based on the principle of using lasers to condense hydrated disc herniation and the accumulated results of the previous literature, the indications of SELD were narrowed to soft disc herniations [16].…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes of Trans-Sacral Epiduroscopic Laser Decompression (SELD) in Patients with Lumbar Disc Herniation

Son

Lee

Ahn

et al. 2020

Pain Research and Management

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Objective. Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results. Methods. Between November 2015 and 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. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom’s criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Results. Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p<0.001). According to Odom’s criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. Conclusion. Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.

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“…SELD is a very successful method in the treatment of chronic low back and/or radicular pain due to spinal disorders. It provides treatment by eliminating the pathology in the epidural space (such as protruded disc material or epidural adhesion and fibrosis around nerve roots) (3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The aim of this study is to share our SELD experience for the treatment of patients with mild to moderate soft lumbar disc herniation with low back and/or radicular pain who have not had low back surgery and have no back surgery indication.…”

Section: Introductionmentioning

confidence: 99%

Sacral Epidural Laser Discectomy Efficacy in Non-Operated Lumbar Disc Herniation-A Single Center Experience

GÜNER¹,

Özgencil²,

ERKEN³

et al. 2022

Osmangazi̇ Journal of Medicine

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Sacral Epidural Laser Discectomy (SELD) which is an effective and minimally invasive procedure for the direct visualization and therapeutic treatment of pain due to spinal disorders. The aim of this study is to share the effect of SELD on clinical findings and pain. 43 patients who had not undergone back surgery and were found to have lumbar intervertebral disc herniation at L4-5 or L5-S1 level without any indication for back surgery, and who underwent SELD for the treatment patients with low back and/or radicular pain were evaluated. Physical examination findings (the straight leg raising test (SLR) <45 degrees positive(+), SLR >45 degrees negative(-) test were accepted) and visual pain scale (VAS) values were evaluated at admission, on the same day of post-op, 1st and 6th months. Disc herniation was observed at L4-5 level in 27 patients (62.79%) and at L5-S1 level in 16 patients (37.21%). 31 patients (72.09%) benefited from SELD treatment, while surgery was recommended for 10 patients (23.26%). With SELD procedure no permanent complication was observed. The clinical response of SELD according to the lumbar disc level, a more significant improvement was found in both physical examination and VAS scores in patients with disc herniation at the L5-S1 level (p<0.001). There was no statistically significant relationship between the SLR (+) side and the outcome. SELD is a more effective option, especially in patients with good physical examination findings at admission and mild-to-moderate soft disc herniation at the L5-S1 level.

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A preliminary study on surgical navigation for epiduroscopic laser neural decompression

Cited by 11 publications

References 45 publications

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

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

Clinical Outcomes of Trans-Sacral Epiduroscopic Laser Decompression (SELD) in Patients with Lumbar Disc Herniation

Sacral Epidural Laser Discectomy Efficacy in Non-Operated Lumbar Disc Herniation-A Single Center Experience

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