Percutaneous Endoscopic Lumbar Discectomy <i>via</i> Transforaminal Approach Combined with Interlaminar Approach for <scp>L4</scp>/5 and <scp>L5</scp>/<scp>S1</scp> Two‐Level Disc Herniation

Zhou, Zhaowei; Ni, Hemin; Zhao, Wei; Gu, Guangfei; Chen, Jia; Zhu, Yanjie; Feng, Chaobo; Gong, Haoyu; Fan, Yunshan; He, Shisheng

doi:10.1111/os.12862

Cited by 23 publications

(11 citation statements)

References 29 publications

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“…Terms for “foraminoplasty” have also differed in name or technique 53,70,71. A systematic review was used to collect information for this analysis;72–86, however, the composition of the algorithm is still dependent on the views of key opinion leaders. Various techniques are considered under the single term “TELD”, including the inside-out technique, outside-in technique, targeted orientation, and half-and-half technique.…”

Section: Discussionmentioning

confidence: 99%

Full-Endoscopic Lumbar Discectomy Approach Selection

Kotheeranurak

Liawrungrueang

Quillo-Olvera

et al. 2023

Spine

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Study Design. A systematic review of the literature to develop an algorithm formulated by key opinion leaders.Objective. This study aimed to analyze currently available data and propose a decision-making algorithm for full-endoscopic lumbar discectomy for treating lumbar disc herniation (LDH) to help surgeons choose the most appropriate approach [transforaminal endoscopic lumbar discectomy (TELD) or interlaminar endoscopic lumbar discectomy (IELD)] for patients. Summary of Background Data. Full-endoscopic discectomy has gained popularity in recent decades. To our knowledge, an algorithm for choosing the proper surgical approach has never been proposed. Materials and Methods. A systematic review of the literature using PubMed and MeSH terms was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Patient samples included patients with LDH treated with full-endoscopic discectomy. The inclusion criteria were interventional research (randomized and nonrandomized trials) and observation research (cohort, case-control, case series). Exclusion criteria were case series and technical reports. The criteria used for selecting patients were grouped and analyzed. Then, an algorithm was generated based on these findings with support and reconfirmation from key expert opinions. Data on overall complications were collected. Outcome measures included zone of herniation, level of herniation, and approach (TELD or IELD). Results. In total, 474 articles met the initial screening criteria. The detailed analysis identified the 80 best-matching articles; after applying the inclusion and exclusion criteria, 53 articles remained for this review. Conclusions. The proposed algorithm suggests a TELD for LDH located in the foraminal or extraforaminal zones at upper and lower levels and for central and subarticular discs at the upper levels considering the anatomic foraminal features and the craniocaudal pathology location. An IELD is preferred for LDH in the central or subarticular zones at L4/L5 and L5/S1, especially if a high iliac crest or high-grade migration is found.

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Section: Discussionmentioning

confidence: 99%

Full-Endoscopic Lumbar Discectomy Approach Selection

Kotheeranurak

Liawrungrueang

Quillo-Olvera

et al. 2023

Spine

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“…Clinical Outcome and Surgical Data According to the revolutionary advances in technology and instruments, PETD is used widely, and is an effective option for almost all types of disc herniation [23][24][25] According to the clinical outcome of PETD, Ren et al 24 reported that the VAS and ODI scores were improved significantly in patients with lumbar disc herniation causing bilateral symptoms. Yeung et al 27 stated that the VAS score was reduced significantly after treatment of symptomatic degenerative conditions using the inside-out transforaminal technique.…”

Section: Discussionmentioning

confidence: 99%

“…According to the revolutionary advances in technology and instruments, PETD is used widely, and is an effective option for almost all types of disc herniation 23 , 24 , 25 . Theoretically, minimally invasive technology could shorten the operation time and reduce the blood loss compared with open lumbar decompression surgery.…”

Section: Discussionmentioning

confidence: 99%

A Comparison Between Retaining and Resecting the Posterior Longitudinal Ligament in Percutaneous Endoscopic Transforaminal Discectomy for Disc Herniation: A Retrospective Cohort Study

Liu

et al. 2022

Orthopaedic Surgery

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Objective To compare the efficacy and safety of retaining the posterior longitudinal ligament (PLL) with resecting the PLL in inside‐out percutaneous endoscopic transforaminal discectomy (PETD) surgery for lumbar disc herniation (LDH). Method A total of 135 patients with symptomatic LDH who were treated by inside‐out PETD surgery from January 2015 to January 2017were included in this retrospective analysis. There were 38 males and 30 females in the PLL resection group (mean age = 52.40 ± 8.73 years) and 35 males and 32 females in the PLL retention group (mean age = 53.50 ± 9.24 years). The visual analogue scale (VAS) score, Oswestry disability index (ODI), and modified MacNab criteria were used to evaluate clinical outcomes. Operation time, blood loss, recurrence of LDH, and complications were recorded. Three months after surgery, magnetic resonance imaging was performed to confirm that nerve root compression was relieved. Results The VAS and ODI scores improved significantly immediately after surgery, at 1 month after surgery, at 3 months after surgery, and at last follow‐up compared with those before surgery (P < 0.01). The scores also improved significantly between immediately after surgery and 1 month after surgery in the two groups (P < 0.001). Multivariate analysis indicated that age ≥ 50 years (odds ratio (OR) = 6.33, 95% confidence interval (CI): 1.64–21.98, P = 0.014), pain duration ≥6 months (OR = 4.68, 95% CI: 1.29–6.51, P = 0.025), pre‐ODI score ≥ 40% (OR = 5.97, 95% CI: 2.41–14.86, P = 0.003) were all associated with poor functional outcomes. There was no significant difference in the excellent/good ratio between the two groups and the mean operation time of the retention group was 71.5% of that of the resection group (82.7 ± 18.5 min vs 115.6 ± 24.6 min, P < 0.01). In the patients, no serious complications, such as dural tear, wound infection, or persistent nerve root injury, were observed during the follow‐up period. There was no significant difference in the complication rate between the two groups (6/68 vs 6/67, P = 0.979). Although the recurrence rate was higher in retention group, there was no significant difference between the two groups (1/68 vs 2/67, P = 0.551). Conclusion The PLL is recommended to be retained for inside‐out PETD surgery.

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“…[30][31][32] Some studies have reported rates as high as 20% for ENR injuries after transforaminal percutaneous endoscopic lumbar discectomy. [33][34][35] As Son et al showed in their work, the risks of incomplete decompression and ENR injuries were higher in an earlier novice stage of training. 36 Tangentially, surgeons in training who may not be as far along the learning curve would benefit from a greater appreciation of the precision needed to perform these procedures at lumbar levels with statistically smaller safe zones.…”

Section: Importance Of Dimensional Trends For Resident Involvementmentioning

confidence: 94%

How dimensions can guide surgical planning and training: a systematic review of Kambin’s triangle

Kouam

Tabarestani

Sykes

et al. 2023

Neurosurgical Focus

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OBJECTIVE The authors sought to analyze the current literature to determine dimensional trends across the lumbar levels of Kambin’s triangle, clarify the role of imaging techniques for preoperative planning, and understand the effect of inclusion of the superior articular process (SAP). This compiled knowledge of the triangle is needed to perform successful procedures, reduce nerve root injuries, and help guide surgeons in training. METHODS The authors performed a search of multiple databases using combinations of keywords: Kambin’s triangle, size, measurement, safe triangle, and bony triangle. Articles were included if their main findings included measurement of Kambin’s triangle. The PubMed, Scopus, Ovid, Cochrane, Embase, and Medline databases were systematically searched for English-language articles with no time frame restrictions through July 2022. RESULTS Eight studies comprising 132 patients or cadavers were included in the study. The mean ± SD age was 66.69 ± 9.6 years, and 53% of patients were male. Overall, the size of Kambin’s triangle increased in area moving down vertebral levels, with L5–S1 being the largest (133.59 ± 4.36 mm2). This trend followed a linear regression model when SAP was kept (p = 0.008) and removed (p = 0.003). There was also a considerable increase in the size of Kambin’s triangle if the SAP was removed. CONCLUSIONS Here, the authors have provided the first reported systematic review of the literature of Kambin’s triangle, its measurements at each lumbar level, and key areas of debate related to the definition of the working safe zone. These findings indicate that CT is heavily utilized for imaging of the safe zone, the area of Kambin’s triangle tends to increase caudally, and variation exists between patients. Future studies should focus on using advanced imaging techniques for preoperative planning and establishing guidelines for surgeons.

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Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two‐Level Disc Herniation

Cited by 23 publications

References 29 publications

Full-Endoscopic Lumbar Discectomy Approach Selection

Full-Endoscopic Lumbar Discectomy Approach Selection

A Comparison Between Retaining and Resecting the Posterior Longitudinal Ligament in Percutaneous Endoscopic Transforaminal Discectomy for Disc Herniation: A Retrospective Cohort Study

How dimensions can guide surgical planning and training: a systematic review of Kambin’s triangle

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