Percutaneous Endoscopic Lumbar Discectomy for Recurrent Disc Herniation: Surgical Technique, Outcome, and Prognostic Factors of 43 Consecutive Cases

Ahn, Yong; Lee, Sang-Ho; Park, Woo-Min; Lee, Ho-Yeon; Shin, Sang-Ha; Kang, Ho-Yeong

doi:10.1097/01.brs.0000134591.32462.98

Cited by 274 publications

(213 citation statements)

References 32 publications

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“…15 In another retrospective study by Ahn et al the mean VAS score decreased significantly from pre-operative to postoperative, and based on the Macnab criteria, 81.4% of the patients met excellent or good outcomes at a mean follow-up duration of 31 months. 16 Lee et al and Lau et al also reported similar findings in their studies. 17,18 In the present study, dural tear reported in one patient in MD group who was successfully managed with primary suturing.…”

Section: Discussionsupporting

confidence: 77%

“…15,18 Back ache and leg pain as seen in seven patients of MD group can occur because of muscle dissection and removal of posterior structures, such as lamina. 16,19 Similarly chronic low back pain was reported in 32% patients in postsurgical group who underwent lumbar laminectomy. 20 Dysesthesias as a complication appeared in four patients in TPELD group.…”

Section: Discussionmentioning

confidence: 99%

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Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

et al. 2017

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INTRODUCTIONDisc prolapse is common in general population with an incidence of 1 in 10,000 populations, requiring surgical intervention in 10% patients. Microdiscectomy (MD) remains the standard procedures for symptomatic lumbar disc prolapse for many decades.1 The procedure is a minimally invasive that involves partial removal of the intervertebral disc compressing the nerve root or spinal cord with the aid of magnifying loupes. The potential benefits of the procedure includes lesser surgical trauma, increased safety owing to good visualization of operative field, lesser postoperative morbidity, and shorter hospitalization.2-4 with most of patients leading a painfree existence.5 Transforaminal Percutaneous endoscopic lumbar discectomy (TPELD) is a relatively new and advanced technique of minimal invasive surgery that involves use of an endoscope to visualize the disc removal through postero-lateral approach through the triangle of Kambin.6,7 The procedure does not require bone or facet resection thus preserving spinal stability. 8,9 TPELD has several advantages; mainly minimal damage ABSTRACT Background: The objective of the study was to compare surgical outcome of micro-discectomy with transforaminal percutaneous endoscopic lumbar discectomy for single level lumbar disc herniation in Indian rural population. Methods: Retrospective comparative study was designed during the period of October 2012 to June 2015, patients in the age group of 22-75 years with unremitting sciatica with/without back pain, and/or a neurological deficit that correlated with appropriate level and side of neural compression as revealed on MRI, with single level lumbar disc herniation who underwent either microdiscectomy or TPELD were included in the study. Patients were assessed on visual analogue scale (VAS) for back and leg pain, modified macnabs criteria, the Oswestry Disability Index (ODI). Results: Group I (MD) included 44 patients and Group II (TPELD) included 20 patients. Significant improvement was seen in claudication symptom post-operatively in both MD and TPELD. Mean operating time was significantly shorter in MD group (1.11 hrs vs. 1.32 hrs; p<0.01). According to modified MacNab's criteria, outcome were excellent (81.8%), good (9.09%) and fair (9.09%) in MD. Similarly, in TPELD, 80%, 15% and 5% patients had excellent, good and fair outcome respectively. In both groups, no one had a poor outcome. Thus, overall success rate was 100% in the study. Conclusions: TPELD and MD have comparable post-operative outcome in most of the efficacy parameters in Indian rural patients undergoing treatment of single level lumbar disc herniation. Additionally, TPELD offers distinct advantages such as performed under local anaesthesia, preservation of structure, lesser post-operative pain and early mobilization and discharge from hospital.

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%

Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

et al. 2017

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“…Also, in younger patients with no anaesthesiologic contra-indications, the acceptability level of postoperative pain and a long hospital stay precludes the realization of conventional surgery in favour of the minimally invasive, same-day operation [17,18]. Other indications were patients with recurrent surgery and spine fibrosis from previous operations [19], where the percutaneous, foraminal endoscopic approach remains the only one that has not been used and a safe route to disc fusion.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it?

Jacquot

Gastambide²

2013

International Orthopaedics (SICOT)

111

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Purpose Interbody spine fusion with cages was first described by Bagby and has been performed for a long time now in a variety of different conditions. We developed a percutaneous endoscopic lumbar fusion technique based on the principles of Kambin and an original titanium cage. Materials and methods From 2004 to 2010, 57 patients were operated on, 17 patients were male with a mean age of 50.29 years (range 34-71 years) and 40 were female with a mean age of 57.42 years (29-90 years). Nineteen patients had a previous operation. Patients were operated on under local anaesthesia in the prone position under image intensifier and a transforaminal percutaneous endoscopic approach. Results Fifty cases had a bilateral cage through a bilateral endoscopic approach, and seven cases had a unilateral endoscopic approach only; of those, three cases had only one cage. Eleven patients had a contemporary posterior plate fixation at the same time of the endoscopic cage fusion. Eight patients had a postoperative radicular pain with paresthesias. Asymptomatic migration of the cages occurred in two cases and symptomatic migration requiring a conventional secondary reoperation in 13 cases after a mean delay of eight months (range three to 36 months). The mean ODI after two years or more was 34.3 % (initial ODI 69.4 %). Conclusions The technique was introduced in our practice to take care of difficult or grave co-morbidity patients, and some patients had excellent lasting results following a very short procedure and hospital stay. However, given the 36 % complication rate in this series, we do not recommend it unless decisive technical improvements are made.

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“…[2][3][4][11][12][13][20][21][22]26,49 Also, full endoscopic techniques have been used for the treatment of LDH via an interlaminar or transforaminal (endoscopic transforaminal discectomy [ETD]) approach. 16,[28][29][30][36][37][38][39][40][41]53 Over the last decade, MED and ETD have been applied to treat recurrent LDH 1,7,14,15,24,25,32,39,43 (Table 1). The outcomes were reported to be equal and sometimes favorable compared with open microdiscectomy for recurrent LDH.…”

mentioning

confidence: 99%

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Hubbe¹,

Franco-Jimenez²,

Klingler³

et al. 2016

SPI

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OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

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Percutaneous Endoscopic Lumbar Discectomy for Recurrent Disc Herniation: Surgical Technique, Outcome, and Prognostic Factors of 43 Consecutive Cases

Cited by 274 publications

References 32 publications

Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

Transforaminal percutaneous endoscopic lumbar discectomy versus microdiscectomy: an Indian rural experience

Percutaneous endoscopic transforaminal lumbar interbody fusion: is it worth it?

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

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