A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

Gibson, J.N.A.; Subramanian, Ajay; Scott, Chloe E H

doi:10.1007/s00586-016-4885-6

Cited by 121 publications

(128 citation statements)

References 27 publications

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“…Furthermore, patients should understand that there is a lack of high-quality evidence on the equivalence of clinical outcomes of PTED compared to OM. However, to the best of our knowledge, PTED is expected to have similar clinical outcomes as compared to OM in the treatment of LDH [2, 6]. Potential complications of PTED are except conversion to OM similar as those of OM and may include dural tear, nerve root injury, deep or superficial wound infection, progressive or persistent neurological complaints, and recurrent LDH.…”

Section: Specific Information To Give the Patient About Surgery And Pmentioning

confidence: 99%

How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

et al. 2018

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BackgroundPercutaneous transforaminal endoscopic discectomy (PTED) has emerged as a less invasive technique to treat symptomatic lumbar disk herniation (LDH). PTED is performed under local anesthesia with the advantage of immediate intraoperative feedback of the patient. In this paper, the technique is described as conducted in our hospital.MethodsPTED is performed under local anesthesia in prone position on thoracopelvic supports. The procedure is explained stepwise: e.g. marking, incision, introduction of the 18-gauge needle and guidewire to the superior articular process, introduction of the TomShidi needle and foraminotomy up to 9 mm, with subsequently removal of disk material through the endoscope. Scar size is around 8 mm.ConclusionPTED seems a promising alternative to conventional discectomy in patients with LDH and can be performed safely.Electronic supplementary materialThe online version of this article (10.1007/s00701-018-3723-5) contains supplementary material, which is available to authorized users.

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Section: Specific Information To Give the Patient About Surgery And Pmentioning

confidence: 99%

How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

et al. 2018

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“…39 All patient-reported outcomes improved significantly in both groups at up to two years from surgery with equivalent benefits in terms of quality of life years gained, both absolute and when discounted to reflect diminishing gain with age. Affected side leg pain was lower in the TED group at two years and hospital stay shorter.…”

Section: Lumbar Spinementioning

confidence: 81%

“…Traditional methods of spinal surgery have been reported to expose the surgeon to significantly greater radiation levels than other non-spinal procedures, with dose rates up to ten to 12 times greater. 18 Even though data suggest that radiation exposure during endoscopic surgery from fluoroscopy is well within a safe range, 39,47 any decrease by computer-assisted/robotic means, or by use of novel electro-magnetic guidance systems, is clearly ideal.…”

Section: Future Developmentsmentioning

confidence: 99%

“…The recent Edinburgh RCT comparing TED and microdiscectomy showed that functional improvements were maintained at two years in both groups but with less ongoing sciatica after TED. 39 There is a clear correlation between outcomes and the operating surgeon’s experience and we would recommend that surgeons start performing all procedures under guidance, after attending technical courses and cadaveric workshops.…”

Section: Future Developmentsmentioning

confidence: 99%

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Multi-level spine endoscopy

Middleton

Wagner²,

Gibson

2017

EFORT Open Reviews

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In the last ten years, there has been an exponential increase in endoscopic spinal surgery practice.With improvements in equipment quality and the availability of high definition camera systems, cervical endoscopic disc resection is now a viable alternative to anterior cervical decompression and fusion (ACDF) or disc arthroplasty for the treatment of disc prolapse and low grade stenosis.Based on the current literature, there is now strong evidence to support the use of transforaminal endoscopic approaches for the treatment of thoracic disc prolapse.There is now level I evidence to show that outcomes following transforaminal endoscopic discectomy (TED) are at least equivalent to those after open microdiscectomy, with an expected shorter operating time, lesser requirement for analgesia, reduced duration of post-operative disability, more rapid rehabilitation and lower costs of care. However, it should be recognised that there is a significant learning curve for TED.New endoscopic techniques with interlaminar approaches allow the decompression of central and lateral recess stenosis. Future developments will facilitate vision and access to the spine with 3D imaging and robotics at the forefront.We present a case report of whole spine endoscopic decompression to illustrate the potential of endoscopic surgery at all spinal levels.Cite this article: EFORT Open Rev 2017;2:317-323. DOI: 10.1302/2058-5241.2.160087

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“…[5][6][7][8][9] Potential advantages of endoscopic diskectomy are less blood loss, lower rate of cerebrospinal fluid (CSF) fistulas and wound infections, as well as shorter length of hospital stay and recovery time compared with microsurgical diskectomy. [10][11][12][13][14] Furthermore, in a systematic review by Nellensteijn et al, clinical results were comparable between transforaminal endoscopic surgery and microdiskectomy. 9 Despite several advantages, endoscopic diskectomy has a significant learning curve (e.g., with longer durations of surgery and a higher reoperation rate).…”

Section: Introductionmentioning

confidence: 92%

Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road

Bender

Gramsch

Herrmann

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Objective Microsurgical diskectomy/sequestrectomy is the standard procedure for the surgical treatment of lumbar disk herniations. The transforaminal endoscopic sequestrectomy technique is a minimally invasive alternative with potential advantages such as minimal blood loss and tissue damage, as well as early mobilization of the patient. We report the implementation of this technique in a German university hospital setting. Methods One single surgeon performed transforaminal endoscopic sequestrectomy from February 2013 to July 2016 for lumbar disk herniation in 44 patients. Demographic as well as perioperative, clinical, and radiologic data were analyzed from electronic records. Furthermore, we investigated complications, intraoperative change of the procedure to microsurgery, and reoperations. The postoperative course was analyzed using the Macnab criteria, supplemented by a questionnaire for follow-up. Pre- and postoperative magnetic resonance imaging volumetric analyses were performed to assess the radiologic efficacy of the technique. Results Our study population had a median age of 52 years. The median follow-up was 15 months, and the median length of hospital stay was 4 days. Median duration of surgery was 100 minutes with a median blood loss of 50 mL. Surgery was most commonly performed at the L4–L5 level (63%) and in caudally migrated disk herniations (44%). In six patients, surgery was performed for recurrent disk herniations. The procedure had to be changed to conventional microsurgery in four patients. We observed no major complications. Minor complications occurred in six patients, and in four patients a reoperation was performed. Furthermore, a significantly lower Oswestry Disability Index score (p = 0.03), a lower Short Form 8 Health Survey (SF-8) score (p = 0.001), a lower visual analog scale (VAS) lower back pain score (p = 0.03) and VAS leg pain score (p = 0.0008) at the 12-month follow-up were observed in comparison with the preoperative examination. In MRI volumetry, we detected a median postoperative volume reduction of the disk herniation of 57.1% (p = 0.02). Conclusions The transforaminal endoscopic sequestrectomy can be safely implemented in a university hospital setting in selected patients with primary and recurrent lumbar disk herniations, and it leads to good clinical and radiologic results. However, learning curve, caseload, and residents' microsurgical training requirements clearly affect the implementation process.

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A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

Cited by 121 publications

References 27 publications

How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

How I do it: percutaneous transforaminal endoscopic discectomy for lumbar disk herniation

Multi-level spine endoscopy

Implementation of Transforaminal Endoscopic Lumbar Sequestrectomy in a German University Hospital Setting: A Long and Rocky Road

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