Analysis of Clinical Results of Three Different Routes of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for Lumbar Herniated Disk

Kim, Hyeun Sung; Yudoyono, Farid; Paudel, Byapak; Kim, Ki Joon; Jang, Jee Soo; Choi, Jeong Hoon; Chung, Sung Kyun; Kim, Jeong Hoon; Jang, Il Tae; Oh, Seong Hoon; Park, Jae Eun; Lee, Sol

doi:10.1016/j.wneu.2017.04.008

Cited by 31 publications

(23 citation statements)

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“…PEILD was done in cases who had LDH at the L5-S1 level. In the PETLD group, as per location of the LDH, they were approached either by the exiting nerve root or intervertebral or suprapedicular approach (24). Foraminoplasty was done using a drill in cases with narrow foramen width and inferiorly migrated LDHs.…”

Section: Methodsmentioning

confidence: 99%

“…We should be aware of native and endoscopic anatomy, LDH characteristics (location of disc, hardness of disc (calcified or soft), hard bony foraminal width, canal occupation by disc, iliac crest height, status of recurrence and presence/absence of discal cyst etc.). Competent knowledge of surgical www.painphysicianjournal.com approaches, technique and special surgical armamentarium are also paramount (9,(12)(13)(14)(15)24).…”

Section: E405mentioning

confidence: 99%

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Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases

Paudel

2018

Pain Phys

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Background: Lumbar disc herniation (LDH) is being treated with limited indication by percutaneous full endoscopic lumbar discectomy. However, microscopic lumbar discectomy (MLD) is still considered as a gold standard. Objective: With the advances in spinal endoscopic instruments and surgical techniques, all LDHs have now become operable with percutaneous full endoscopic lumbar discectomy procedure. We report the results of percutaneous full endoscopic lumbar discectomy (PELD) for all patients diagnosed with LDH, including severely difficult and extremely difficult LDH cases who visited our clinic with leg pain and lower back pain. Study Design: Retrospective study of consecutive prospective patients. Setting: Spine center, Nanoori Suwon Hospital, Suwon, Korea. Methods: Electronic medical records of 98 consecutive patients (104 levels) who underwent surgery from October 2015 to May 2016, by PELD for different LDHs either by percutaneous endoscopic transforaminal lumbar discectomy (PETLD) or percutaneous endoscopic interlaminar lumbar discectomy (PEILD) approach were reviewed retrospectively. The L5-S1 level was accessed with PEILD approach and the other levels were accessed with PETLD approach. Outcomes were analyzed utilizing the visual analog scale (VAS), Oswestry disability index (ODI), Mac Nab Criteria and endoscopic surgical success grade/score. Results: There were 75 (72.1%) men and 29 (27.9%) women patients with a mean age of 48.12 ± 15.88 years. Follow-up range from a minimum of 10 to 15 months (mean 12.77 ± 1.84 months). Most of the LDHs were located at L4-5 level. There were 76% severely difficult and extremely difficult cases. PETLD was the choice of approach in most of the cases (78 cases, 75%). VAS decreased significantly. ODI improved from preoperative 54.67 ± 7.52 to 24.50 ± 6.45 at last follow-up. 96.1% good to excellent result was obtained as per Mac Nab criteria. 98.1% of patients were managed with a successful to completely successful grade according to the endoscopic surgical success grading/ scoring. Two cases (1.9%) developed transient motor weakness. Limitation: Retrospective analysis of consecutive prospective patients. Conclusion: With more than 96% success (98.1% as per endoscopic success grading/scoring) all kinds of LDHs, including severely difficult and extremely difficult LDHs, are accessible by the PELD (PETLD and PEILD) technique. PELD can now be considered an alternative to microscopic lumbar discectomy (MLD) in the treatment of all kinds of disc herniations with the added benefits of keyhole surgery even for severely difficult and extremely difficult LDH cases. Key words: Lumbar disc herniation (LDH), percutaneous endoscopic lumbar discectomy (PELD), percutaneous endoscopic transforaminal lumbar discectomy (PETLD), percutaneous endoscopic interlaminar discectomy (PEILD), evolution of PELD, difficult LDH, highly migrated LDH, high canal compromised LDH, revision LDH, LDH with discal cyst, calcified LDH

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Section: Methodsmentioning

confidence: 99%

Section: E405mentioning

confidence: 99%

Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases

Paudel

2018

Pain Phys

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“…Although conservative treatment has been usually proposed for LDH patients, some patients whose symptoms has not improved with conservative management may still require surgical intervention [2]. Among the operative methods, open lumbar discectomy and fusion is considered to be the gold standard treatment of LDH [3,4].However, the procedure make damage to muscular and ligamentous structures and require prolonged hospital stays and expensive hospitalization cost. Nowadays, percutaneous endoscopic lumbar discectomy (PELD) has become a popular surgical option for the management of LDH, Since the posterolateral nucleotomy technique was rst introduced by Kambin and Gellman [5][6][7] .…”

Section: Page 3/12mentioning

confidence: 99%

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

Liu

et al. 2020

Preprint

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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.

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“…The skin entry point was marked at the midline of the disk space. An 18-gauge spinal needle was inserted at the point using the manual back muscle assessment method 3) , approximately 12-14 cm away from the vertebral midline and at 25-35 degree angle. After passing through the fascia and back muscle, the needle was docked at Kambin's triangle, near the intervertebral disk.…”

Section: Case Reportmentioning

confidence: 99%

Percutaneous Endoscopic Transforaminal Lumbar Discectomy For Massive Disc Herniation Causing Cauda Equina Syndrome: A Case Report

Kim

Adsul

et al. 2018

J Minim Invasive Spine Surg Tech

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Traditional open and microscopic approaches for lumbar discectomy in cauda equina syndrome are associated with retraction of thecal sac and nerve root which was already compromised. Our study looks upon a case of cauda equina syndrome due to massive disc herniation which was operated by percutaneous endoscopic transforaminal lumbar discectomy (PETLD) using outside in technique. The procedure is done under local anesthesia with minimal soft tissue damage and allows early rehabilitation with the better aesthetic outcome. PETLD is a safe and effective alternative to emergently decompress the lumbar spine with prompt recovery.

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Analysis of Clinical Results of Three Different Routes of Percutaneous Endoscopic Transforaminal Lumbar Discectomy for Lumbar Herniated Disk

Cited by 31 publications

References 12 publications

Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases

Percutaneous Endoscopic Lumbar Discectomy for All Types of Lumbar Disc Herniations (LDH) Including Severely Difficult and Extremely Difficult LDH Cases

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

Percutaneous Endoscopic Transforaminal Lumbar Discectomy For Massive Disc Herniation Causing Cauda Equina Syndrome: A Case Report

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