Minimally Invasive Endoscopic Removal of a Herniated Nucleus Pulposus that had Migrated to the S1 Nerve Root Foramen

Tonogai, Ichiro; Sairyo, Koichi; Higashino, Kosaku; Sakai, Takayuki; Katoh, Shinsuke; Yasui, Nanako

doi:10.1055/s-2007-982510

Cited by 7 publications

(5 citation statements)

References 2 publications

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“…In our department, we initiated endoscopic surgery in August 2000. At the beginning endoscopic surgery was only indicated for a herniated nucleus pulposus [20,21] . In 2001, the technique was also applied for LCS.…”

Section: Contra-lateral Nerve Rootmentioning

confidence: 99%

Minimally Invasive Endoscopic Bilateral Decompression with a Unilateral Approach (endo-BiDUA) for Elderly Patients with Lumbar Spinal Canal Stenosis

Wada

Sairyo

Sakai

et al. 2010

Minim Invasive Neurosurg

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Section: Contra-lateral Nerve Rootmentioning

confidence: 99%

Minimally Invasive Endoscopic Bilateral Decompression with a Unilateral Approach (endo-BiDUA) for Elderly Patients with Lumbar Spinal Canal Stenosis

Wada

Sairyo

Sakai

et al. 2010

Minim Invasive Neurosurg

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“…6,12,13,33,35,75,78,105,108–111 Although OD performed with or without an operating microscope (known as microdiscectomy) remains the standard approach to the lumbar disc, 24,39,48,63,79,100 tubular retractor system–based MID has been increasingly performed. 1–3,11,14,17,18,20,21,23,31,42,44,45,47,50,51,53,57–61,66,67,69,72,73,77,81,85,87–90,95,103,104,106,112–114 Potential benefits to this technique include less muscle damage, 9,52,91–93 decreased pain, 32,37 and faster recovery period after surgery. 71,115 However, before MID becomes more widely adopted, its efficacy compared with OD must be systematically evaluated.…”

mentioning

confidence: 99%

The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials

Dasenbrock

Juraschek

Schultz

et al. 2012

SPI

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Object Advocates of minimally invasive discectomy (MID) have promoted this operation as an alternative to open discectomy (OD), arguing that there may be less injury to the paraspinal muscles, decreased postoperative pain, and a faster recovery time. However, a recently published large randomized controlled trial (RCT) comparing these approaches reported inferior relief of leg pain in patients undergoing MID. The authors conducted a meta-analysis to evaluate complications and improvement in leg pain in patients with radiculopathy enrolled in RCTs comparing OD to MID. Methods The authors performed a literature search using Medline and EMBASE of studies indexed between January 1990 and January 2011. Predetermined RCT eligibility included the usage of tubular retractors during MID, a minimum follow-up duration of 1 year, and quantification of pain with the visual analog scale (VAS). Trials that only evaluated patients with recurrent disc herniation were excluded. Data on operative parameters, complications, and VAS scores of leg pain were extracted by 2 investigators. A meta-analysis was performed assuming random effects to determine the difference in mean change for continuous outcomes and the risk ratio for binary outcomes. Results Six trials comprising 837 patients (of whom 388 were randomized to MID and 449 were randomized to OD) were included. The mean operative time was 49 minutes during MID and 44 minutes during OD; this difference was not statistically significant. Incidental durotomies occurred significantly more frequently during MID (5.67% compared with 2.90% for OD; RR 2.05, 95% CI 1.05–3.98). Intraoperative complications (incidental durotomies and nerve root injuries) were also significantly more common in patients undergoing MID (RR 2.01, 95% CI 1.07–3.77). The mean preoperative VAS score for leg pain was 6.9 in patients randomized to MID and 7.2 in those randomized to OD. With long-term follow-up (1–2 years postoperatively), the mean VAS score improved to 1.6 in both the MID and OD cohorts. There was no significant difference in relief of leg pain between the 2 approaches with either short-term follow-up (2–3 months postoperatively, 0.81 points on the VAS, 95% CI −4.71 to 6.32) or long-term follow-up (2.64 on the VAS, 95% CI −2.15 to 7.43). Reoperation for recurrent herniation was more common in patients randomized to the MID group (8.50% compared with 5.35% in patients randomized to the OD group), but this difference was not statistically significant (RR 1.56, 95% CI 0.92–2.66). Total complications did not differ significantly between the operations (RR 1.50, 95% CI 0.97–2.33). Conclusions The current evidence suggests that both OD and MID lead to a substantial and equivalent long-term improvement in leg pain. Adequate decompression, regardless of the operative approach used, may be the primary determinant of pain relief—the major complaint of many patients with radiculopathy. Incidental durotomies occurred significantly more frequently during MID, but total complications did not differ betwe...

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“…However, limitations to the access to the resection of highly migrated herniated discs within the spinal canal still exist. The osseous edge of the foramen and the nerve can limit working mobility and removal of the migrated herniated disc (11,(13)(14)(15)(16). In addition, the posterior iliac crest and the anterior abdominal structures may block access.…”

Section: Tf-peldmentioning

confidence: 99%

“…Open surgery was recommended for highly migrated LDH due to a high chance of failure through the TF route (21,22). Recently, removal of the highly migrated LDH with PELD has been reported occasionally (1,5,14,16,23). However, none of the existing research has systematically described the selection of the most appropriate procedure from the 3 approaches or the individualization of operative procedures in different cases.…”

Section: Il-peld Versus Tf-peldmentioning

confidence: 99%

Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated Lumbar Disc Herniation

et al. 2017

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Background: Percutaneous endoscopic lumbar discectomy (PELD) has been growing in popularity for the treatment of lumbar disc herniation (LDH) due to its irreplaceable advantages over conventional open surgery. Compared with common lumbar disc herniations, discectomy of highly migrated LDH by PELD is known to be very difficult. Highly migrated lumbar disc herniation has long been a challenge for its specific characteristics. Three approaches for PELD have been applied to access a highly migrated LDH, including an interlaminar approach (IL), transforaminal approach (TF), and contralateral transforaminal approach (CTF). However, none of the existing research has systematically described the selection of the most appropriate procedure from the 3 approaches or the individualization of an operative procedure in different cases. Objectives: The purpose of this study was to present a detailed surgical approach selection and individualization of procedure in the treatment of highly migrated LDH with PELD. We also mean to compare the outcomes of patients with highly migrated LDH treated with PELD by the 3 approaches. Study Design: Single-center retrospective observational study. Setting: An interventional pain management practice, a medical center, major metropolitan city, China. Methods: In our retrospective analysis between March 2011 and March 2013, 73 patients with single level highly migrated LDH received PELD. Clinical outcomes were assessed with the visual analogue scale (VAS) score, the modified MacNab criteria, and the Oswestry disability index (ODI). Relevant data such as operation duration and fluoroscopy frequency of the 3 operative approaches were recorded. Results: The mean operating time of IL was 56 minutes, compared with 64 minutes for TF and 112 minutes for CTF. The mean intraoperative fluoroscopy times were 5.5 for IL, 9.7 for TF, and 14.6 for CTF. In each group, the mean VAS and ODI after surgery and 3 months after surgery improved dramatically compared with preoperative counterparts. However, the difference between postoperative results and the results 3 months after surgery was not significant (P > 0.05). The overall excellent rate was 90.4% according to the modified MacNab criteria; there was no significant statistical difference between the 3 operative routes. Operative complications occurred in 3 patients (2 after IL and one after CTF, 3 of 73, 4.1%). Limitations: This study is limited by its sample size. Conclusion: In our research, PELD with all 3 approaches was similarly effective to highly migrated disc herniation. The CTF approach required the longest operation duration and the most intraoperative times. On the contrary, the least operation time and radiographfrequency was required with the IL approach. In addition, we came to a conclusion of surgery approach selection when it comes to varied HM-LDH. Key words: Highly migrated, lumbar disc herniation, percutaneous endoscopic lumbar discectomy, minimally invasive treatment Pain Physician 2017;

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Minimally Invasive Endoscopic Removal of a Herniated Nucleus Pulposus that had Migrated to the S1 Nerve Root Foramen

Cited by 7 publications

References 2 publications

Minimally Invasive Endoscopic Bilateral Decompression with a Unilateral Approach (endo-BiDUA) for Elderly Patients with Lumbar Spinal Canal Stenosis

Minimally Invasive Endoscopic Bilateral Decompression with a Unilateral Approach (endo-BiDUA) for Elderly Patients with Lumbar Spinal Canal Stenosis

The efficacy of minimally invasive discectomy compared with open discectomy: a meta-analysis of prospective randomized controlled trials

Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated Lumbar Disc Herniation

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