Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique

Aydın, Yunus; Ziyal, Ibrahim M.; Duman, Hüdayi; Türkmen, Cengiz S.; Başak, Muzaffer; Şahin, Yüksel

doi:10.1016/s0090-3019(01)00677-2

Cited by 81 publications

(59 citation statements)

References 39 publications

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“…About 5-12 % of failed back syndrome is caused by epidural fibrosis in patients who underwent lumbar disk surgery [24]. Reduced trauma to the ligamentum flavum appears to limit epidural fibrosis [25]. In standard open microscopic discectomy, about the same amount of the ligamentum flavum is removed as with laminotomy.…”

Section: Discussionmentioning

confidence: 99%

Learning curve of full-endoscopic lumbar discectomy

et al. 2012

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Purpose To report the learning curve of full-endoscopic lumbar discectomy for a surgeon naive to endoscopic surgery but trained in open microdiscectomy. Methods From July 2006 to July 2009, 57 patients underwent full-endoscopic lumbar discectomy and 66 underwent open microdiscectomy. The clinical results were evaluated with a visual analog scale (VAS) and the Oswestry Disability Index (ODI). Spearman's coefficient of rank correlation (rho) was used to assess the learning curves for the transforaminal and interlaminar procedures of full-endoscopic lumbar discectomy. Results After full-endoscopic lumbar discectomy, the VAS and ODI results of the patients followed up were comparable with those of open microdiscectomy. A steep learning curve was observed for the transforaminal procedure, but not the interlaminar procedure. Conclusions The learning curve of the transforaminal approach was steep and easy to learn, while the learning curve of the interlaminar approach was flat and hard to master.

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Section: Discussionmentioning

confidence: 99%

Learning curve of full-endoscopic lumbar discectomy

et al. 2012

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“…Only 25 studies met the inclusion criteria and were then fully read. In a consensus meeting the authors further discarded another 15 articles: Wilson et al [35], Kho et al [17], Nystrom et al [22], Kahanovitz et al [14], Silvers et al [27], Andrews et al [1], Barrios et al [3], Caspar et al [5], Striffeler et al [28], Stevens et al [29], Schmidt et al [26], Aydin et al [2], Nakagawa et al [21], Toyone et al [30], and Schizas et al [25]. Reasons for exclusion of these articles are described in Table 1.…”

Section: Methodsmentioning

confidence: 99%

A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations

Gotfryd¹,

Avanzi²

2008

International Orthopaedics (SICO

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The focus of this study was to examine the safety and effectiveness of three different discectomy techniques using a posterior approach for the treatment of herniated lumbar discs. There are only a small number of prospective randomised studies comparing posterior lumbar discectomy techniques, and no recent systematic review has been published on this matter. Using the Cochrane Collaboration guidelines, all randomised or "quasi-randomised" clinical trials, comparing classic, microsurgical, and endoscopic lumbar discectomies using a posterior approach were systematically reviewed. No statistically significant differences were found between these techniques regarding improvement in pain, sensory deficits, motor strength, reflexes, and patient satisfaction. Current data suggest that the microsurgical and endoscopic techniques are superior to the classic technique for the treatment of single level lumbar disc herniations with respect to volume of blood loss, systemic repercussions, and duration of hospital stay. All three surgical techniques were found to be effective for the treatment of single level lumbar disc herniations in patients without degenerative vertebral deformities. No conclusions could be drawn from the clinical randomised studies reviewed regarding the safety of the three techniques studied due to insufficient data on postoperative complications.Résumé L'objectif de cette étude est d'évaluer trois techniques différentes de discectomie après abord postéri-eur du rachis lors du traitement des hernies discales lombaires. Il existe un petit nombre d'études prospectives randomisées comparant les techniques de discectomies par voie postérieure lombaire. Aucune revue systématique n'a été publiée. En utilisant la base de Cochrane, nous avons étudié de façon systématique un certain nombre d'études comparant les discectomies par voie micro chirurgicale classique ou par endoscopie. Aucune différence significative n'a été trouvée entre toutes ces techniques tant sur le plan de l'amélioration de la douleur que des déficits sensoriels, des problèmes moteurs ou des réflexes et de la satisfaction des patients. Les données de la littérature suggèrent que la micro chirurgie et les techniques d'endoscopie sont supérieures aux techniques classiques dans le traitement d'une hernie à un seul niveau, notamment en ce qui concerne les pertes sanguines, les complications systémiques et la durée de séjour. Ces trois techniques sont des techniques qui peuvent être utilisées pour les hernies discales à un seul niveau chez les patients qui ne présentent pas de déformations dégénératives de la colonne vertébrale. Aucune conclusion ne peut être donnée concernant la revue des études cliniques randomisées, notamment en ce qui concerne l'absence de complications sur les trois techniques utilisées. Ceci est secondaire à l'insuffisance des données de la littérature sur les complications post-opératoires.

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“…2,3,9,[17][18][19]21,25,26,28,33,36,[41][42][43]45,49,[52][53][54][56][57][58]61 MED techniques employ a longitudinal paramedian incision through which a tubular retractor is placed and visualization is achieved through an endoscope. 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.…”

Section: Data Collectionmentioning

confidence: 99%

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

Shriver¹,

Xie

Tye³

et al. 2015

FOC

120

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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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Clinical and radiological results of lumbar microdiskectomy technique with preserving of ligamentum flavum comparing to the standard microdiskectomy technique

Cited by 81 publications

References 39 publications

Learning curve of full-endoscopic lumbar discectomy

Learning curve of full-endoscopic lumbar discectomy

A systematic review of randomised clinical trials using posterior discectomy to treat lumbar disc herniations

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

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