Automated Percutaneous Discectomy: A Prospective Multi-Institutional Study

Onik, Gary; Mooney, Vert; Maroon, Joseph C.; Wiltse, Leon L.; Helms, Clyde A.; Schweigel, Joseph F.; Watkins, Robert G.; Kahanovitz, Neil; Day, Arthur L.; Morris, James M.; McCullough, John A.; Reicher, Murray A.; Croissant, Paul D.; Dunsker, Stewart B.; Davis, William G.; Brown, Courtney W.; Hochschuler, Stephen H.; Saul, Thomas; Ray, Charles D.

doi:10.1227/00006123-199002000-00007

Cited by 158 publications

(59 citation statements)

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“…2,6,10,13,19,24,25,29,36,46,51,53,57,60,62,64 Percutaneous discectomy entails placing a sheath directly into the disc space via a transforaminal approach, extraforaminal approach, or interlaminar approach and then using a suction/debrider or chemical injection to remove the disc. 1,11,12,23,30,37,44,50 To assess the risk of bias for each study, 3 reviewers (M.F.S., J.J.X., and E.Y.T.) independently investigated the individual studies and used The Cochrane Collaboration's tool for assessing risk of bias.…”

Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

126

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OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

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Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

126

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“…A lateral oblique projection (35°-40°rotation of the tube) is used for disc space definition at the thoracic level [1,16].…”

Section: Trocar Positioning At Thoracic Spinementioning

confidence: 99%

Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

Kelekis

Filippiadis

Martin

et al. 2010

Cardiovasc Intervent Radiol

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Percutaneous treatments are used in the therapy of small-to medium-sized hernias of intervertebral discs to reduce the intradiscal pressure in the nucleus and theoretically create space for the herniated fragment to implode inward, thus reducing pain and improving mobility and quality of life. These techniques involve the percutaneous removal of the nucleus pulposus by using a variety of chemical, thermal, or mechanical techniques and consist of removal of all or part of nucleus pulposus to induce more rapid healing of the abnormal lumbar disc. These guidelines are written to be used in quality improvement programs for assessing fluoroscopy-and/or computed tomography-guided percutaneous intervertebral disc ablative techniques.

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“…Percutaneous discectomy using an automated probe [7] and laser nucleolysis [2,10] are performed without benefit of fiberoptic visualization and involve an attempted decompression by limited medial nucleotomy. Biportal arthroscopic microdiscectomy [4] entails annulectomy and removal of disc material from the unaffected side to allow extensive exploration of the intervertebral space.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous lumbar discectomy with a working endoscope and laser assistance

Savitz

Doughty

Burns

1998

FOC

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The authors describe percutaneous disc surgery performed via the unilateral monoportal method with a C-arm image intensifier, a working endoscope, and an yttrium-aluminum-garnet laser in 300 patients at three community hospitals over a 6-year period. Visualizing the area of the annulus to be fenestrated, verifying the status of the nerve root, inspecting the cavity created, and monitoring laser hemostasis and vaporization all contributed to patient safety. Fewer than 2% of the cases required a second surgery. The only postoperative sequelae recorded were one psoas hematoma, which resolved, and sympathetic mediated pain in 5% of the patients who responded to appropriate treatment. For treatment of a prolapsed lumbar disc, a 1-hour endoscopic procedure performed while the patient receives a neuroleptanalgesic continues to be a significant surgical alternative.

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Automated Percutaneous Discectomy: A Prospective Multi-Institutional Study

Cited by 158 publications

References 0 publications

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Standards of Practice: Quality Assurance Guidelines for Percutaneous Treatments of Intervertebral Discs

Percutaneous lumbar discectomy with a working endoscope and laser assistance

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