Gradient local anesthesia for percutaneous endoscopic interlaminar discectomy at the L5/S1 level: a feasibility study

Abstract

Background During the process of shearing the ligamentum flavum, rotating the working channel, and manipulating the annulus fibrosis, the sinuvertebral nerve and the spinal nerve root can be irritated, inducing intolerable back and leg pain. Thus, GA is recommended and well accepted by most surgeons when performing PELD via the interlaminar approach. The aim of our study was to explore the efficacy and safety of percutaneous endoscopy interlaminar lumbar discectomy with gradient LA in patients with L5/S1 disc herniation. Methods This retrospective study was conducted between December 2017 and June 2018. The study included 50 consecutive patients who met the study criteria, had single-level L5/S1 disc herniation, and underwent PELD via the interlaminar approach under gradient LA. Different concentrations of LAC were injected into different tissues inside and outside the ligamentum flavum to complete gradient LA. The evaluation criteria included the intraoperative satisfaction score, VAS score, ODI, complications and adverse reactions. Results The intraoperative satisfaction score was consistently over 7, with an average score of 9.3±0.7, indicating that LAC can achieve satisfactory pain control throughout the PELD operation without additional anesthesia. The postoperative VAS score and ODI were dramatically improved at each follow-up interval (P < 0.001, respectively). There was no serious complication such as dural rupture caused by puncture, dural laceration caused by manipulation under endoscopy, total spinal anesthesia, iatrogenic nerve root injury, epidural hematoma, infections or local anesthetic-related adverse reactions. Three patients experienced transient postoperative dysesthesia of the lower limbs that gradually recovered within 24 hours. Conclusions Gradient local anesthesia can satisfactorily and safely control intraoperative pain during the PELD via the interlaminar approach. It can not only improve intraoperative satisfaction, but also reduce local anesthesia-related adverse reactions and surgery-related complications.

Application of a new body surface-assisting puncture device in percutaneous transforaminal endoscopic lumbar discectomy

“…However, PELD has several practical issues. First, it requires repeated blind puncture through the skin to reach the target which can result in iatrogenic injury, the most common of which is nerve root and dural injury [11]. Second, when the puncture is inaccurate, especially when the surgeon is inexperienced, multiple repeat punctures together with X-ray fluoroscopy are required, increasing the operation time and relevant surgery risk and exposing both medical staff and patients to X-ray radiation.…”