Comparative study of three minimally invasive surgical approaches for the treatment of l5/s1 lumbar intervertebral disc herniation

Hu, Wei; Shunli, Kan; Ze-hua, Jiang; Zhang, Tengfei; Yidong, Liu; Zhu, Rong

doi:10.5137/1019-5149.jtn.29539-20.2

Cited by 6 publications

(23 citation statements)

References 11 publications

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“…However, the transforaminal approach cannot effectively decompress central stenosis because of limitations in the surgical field. Traditional PETD is mainly applied to the resection of soft herniation disc fragments (free body); in the resection of the degenerated disc (no free body), the surgery is more challenging 5,7 …”

Section: Introductionmentioning

confidence: 99%

“…Traditional PETD is mainly applied to the resection of soft herniation disc fragments (free body); in the resection of the degenerated disc (no free body), the surgery is more challenging. 5,7 Unilateral biportal endoscopic decompression is a percutaneous, full endoscopic technique. Bilateral decompression via unilateral laminotomy was the main feature.…”

Section: Introductionmentioning

confidence: 99%

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“Inside Disc Out” Discectomy for the Treatment of Discogenic Lumbar Spinal Canal Stenosis under the Intervertebral Foramen Endoscope

Sun

Wang

Xue

2022

Orthopaedic Surgery

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Objective Conventional posterior‐approach decompression surgeries have a higher risk of nerve root injury and dura laceration. We explore the therapeutic strategy and effect of “inside disc out” discectomy under intervertebral foramen endoscope technique for discogenic lumbar spinal canal stenosis (DLSS) treatment. Methods Twenty‐nine patients with DLSS in the responsible segment were treated with “inside disc out” discectomy under intervertebral foramen endoscope technique between October 2017 to October 2019. Lower limb and back pain were recorded before operation, and visual analogue scale (VAS) score and Oswestry disability index (ODI) were recorded for lower limb and back pain at 1, 3, 6, and 12 months postoperatively. The postoperative effects were evaluated using the modified MacNab method for all the patients. Results All 29 patients successfully completed the operation. The operation time was 75–120 min, with an average of 90 ± 17 min. Postoperative lumbar CT examinations of all the patients showed full decompression of the spinal cord with no residual pressure. The average follow‐up time for all the patients was 13 ± 3.5 months (12–18 months). The VAS score for lower back and lower limb pain was 7.52 ± 1.25 before the operation, and 1.80 ± 0.63, 1.33 ± 0.88, 1.07 ± 0.89, and 0.81 ± 0.51 at 1, 3, 6, and 12 months after the surgery, respectively. The Oswestry dysfunction index was 59.43 ± 10.04 before surgery and 29.67 ± 10.35, 21.13 ± 9.32, 14.52 ± 5.98, and 9.84 ± 4.68 at 1, 3, 6, and 12 months after the surgery, respectively. The VAS score and ODI index of low back and lower limb pain at different time points after the surgery were significantly improved compared to those before the surgery (P < 0.01). The effect of the modified MacNab was excellent in 26 patients, good in two patients, and fair in one patient. The excellent and good rates were 91.4%. Among them, one patient had symptoms of hyperesthesia in the anterior aspect of the thigh and decreased quadriceps muscle strength after lumbar 4/5 segment endoscopic surgery. After symptomatic and conservative treatment, the symptoms disappeared 4 weeks postoperatively, and there were no other serious surgical complications. Conclusions Following the “inside disc out” discectomy under intervertebral foramen endoscope protocols, the risk of nerve injury can greatly be reduced, with good postoperative efficacy. Overall, the procedure is safe and feasible for DLSS treatment.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Inside Disc Out” Discectomy for the Treatment of Discogenic Lumbar Spinal Canal Stenosis under the Intervertebral Foramen Endoscope

Sun

Wang

Xue

2022

Orthopaedic Surgery

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“…The technical advancement in endoscopes and instruments have led to the development of multiple approaches including the transforaminal, the extra foraminal and the interlaminar approach. The interlaminar approach is used in lumbar spinal stenosis and disc herniation mainly located inside the spinal canal, which is technically difficult to manage through the transforaminal technique, and especially at L5-S1 due to the large transverse processes, facets, the narrow disk space and the iliac crest [2][3] . Ruetten et al performed for first time the full-endoscopic discectomy by transforaminal [4] and interlaminar [5] approaches.…”

Section: Introductionmentioning

confidence: 99%

“…Using: Paired Sample t-test; * significant difference Table[3]: Distribution of patients according to their evaluation by Modified Macnab Criteria at the end of the postoperative third month [n=20].…”

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confidence: 99%

Endoscopic Management of Lumbar Disc Prolapse

Mahmoud

Almelesy

Mohamed

2021

International Journal of Medical Arts

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Background: Endoscopic management of lumbar disc herniation as a minimally invasive procedure become more popular around the world. Although accepted surgical outcomes of the endoscopic approach to manage lumbar disc herniation [LDH], this procedure still to be relatively challenging and needs a high learning curve, so operative failures and complications may occur. The Aim of The Work:To assess using the endoscope in the management of lumbar disc prolapse by interlaminar approach using Easy Go and Destandau systems.Patients and Methods: This is study included twenty patients, who had lumbar disc herniation, and operated by using Easy Go and Destandau's endoscopic systems after the failure of conservative treatment. They were included between March 2016 and April 2020. They followed up for at least three months postoperatively. All were selected from the Neurosurgery Department,

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“…8 In recent years, several observational retrospective studies have also tried to compare these two surgical procedures, but none of them have completed long-term follow-up (more than four years). [9][10][11][12][13] Here, we report the long-term results of our RCT focusing on the five-year clinical outcomes based on various patient-reported outcome measures (PROMs), and the five-year recurrence rate.…”

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confidence: 99%

Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation: 5-year Long-term Results of a Randomized Controlled Trial

Chen

Zhang

Dong

et al. 2022

Spine

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Study Design. A prospective randomized controlled study. Objective. To compare the efficacy and safety between percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED). Summary of Background Data. Two kinds of minimally invasive discectomy, PTED and MED, are now widely used for treating lumbar disk herniation (LDH). The long-term comparative results of these two techniques still remained uncertain. Materials and Methods. In this single-center, open-label, randomized controlled trial, patients were included if they had persistent signs and symptoms of radiculopathy with corresponding imaging-confirmed LDH and were randomly allocated to PTED or MED groups. The primary outcome was the score of Oswestry Disability Index (ODI) and the secondary outcomes included the score of Medical Outcomes Study 36-Item Short-Form Health Survey bodily pain (SF36-BP) and physical function (SF36-PF), European Quality of Life—Five Dimensions (EQ-5D), Visual Analog Scales for back pain (VAS-back) and leg pain (VAS-leg). Results. A total of 241 patients were accepted to enroll in our randomized controlled trial, of which 119 were randomly assigned to the PTED group, and the rest 122 were assigned to the MED group. A total of 194 out of 241 patients (80.5%) completed the five-year follow-up. PTED group was associated with shorter postoperative in-bed time and length of hospital stay. Both primary and secondary outcomes did not differ significantly between the two treatment groups at each follow-up time point. During the five-year follow-up, seven recurrent cases occurred in PTED and MED groups, respectively. Conclusion. Over the five-year follow-up period, PTED and MED were both efficacious in the treatment of LDH. The long-term clinical outcomes and recurrent rates were comparable between the treatment groups. PTED represents a more minimally invasive technique with the advantages of rapid recovery.

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Comparative study of three minimally invasive surgical approaches for the treatment of l5/s1 lumbar intervertebral disc herniation

Cited by 6 publications

References 11 publications

“Inside Disc Out” Discectomy for the Treatment of Discogenic Lumbar Spinal Canal Stenosis under the Intervertebral Foramen Endoscope

“Inside Disc Out” Discectomy for the Treatment of Discogenic Lumbar Spinal Canal Stenosis under the Intervertebral Foramen Endoscope

Endoscopic Management of Lumbar Disc Prolapse

Percutaneous Transforaminal Endoscopic Discectomy Versus Microendoscopic Discectomy for Lumbar Disc Herniation: 5-year Long-term Results of a Randomized Controlled Trial

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