Percutaneous Endoscopic Lumbar Discectomy (PELD) via a Transforaminal and Interlaminar Combined Approach for Very Highly Migrated Lumbar Disc Herniation (LDH) Between L4/5 and L5/S1 Level

Zhao, Yongzhao; Fan, Yunshan; Liu, Yang; Ni, Hemin; Wang, Chuanfeng; He, Shisheng; Gu, Guangfei

doi:10.12659/msm.922777

Cited by 15 publications

(12 citation statements)

References 15 publications

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“… 29 , 31 , 33 It should be noted that the target location, limited possibility of endoscopic adjustment, and risks of dural tears and incomplete removal of the herniated disc may limit the application of these methods. 29 , 31 , 33 Two-level PELD techniques such as the transforaminal approach alone or in combination with an interlaminar approach reduce the incidence of postoperative nucleus pulposus residue, 30 , 32 but these procedures are cumbersome, have a long operative time, and cannot be used for L5–S1 far-migrated LDH. 29 , 32 The results of our study show that sciatica in both the IELD and IMLD groups significantly improved and remained satisfactory at the 24-month follow-up, indicating that adequate decompression was achieved, which is in accordance with other published reports.…”

Section: Discussionmentioning

confidence: 99%

“…Although the incidence of complications was higher with the latter, no major complications occurred. Modified PELD techniques have been used to treat farmigrated LDH, with good clinical results; 20,22,[29][30][31][32][33] However, these methods have various shortcomings and limitations. Several studies have reported good clinical results in more than 90% of patients with far-migrated DH treated by PETLD, but it is difficult to directly view the distal free nucleus pulposus due to obstruction of the facet joint and pedicle, especially as the far-migrated disc is often separated into many fragments.…”

Section: Discussionmentioning

confidence: 99%

“…29,31,33 Two-level PELD techniques such as the transforaminal approach alone or in combination with an interlaminar approach reduce the incidence of postoperative nucleus pulposus residue, 30,32 but these procedures are cumbersome, have a long operative time, and cannot be used for L5-S1 farmigrated LDH. 29,32 The results of our study show that sciatica in both the IELD and IMLD groups significantly improved and remained satisfactory at the 24-month followup, indicating that adequate decompression was achieved, which is in accordance with other published reports. 15,16,[35][36][37] An interlaminar approach was used in the IELD group as the anatomic structure was easier to identify under endoscopy; this is in line with the operating habits of most spine surgeons.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic and Microscopic Interlaminar Discectomy for the Treatment of Far-Migrated Lumbar Disc Herniation: A Retrospective Study with a 24-Month Follow-Up

Fei¹,

Ren²,

Ye³

et al. 2021

JPR

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Purpose Percutaneous endoscopic lumbar discectomy for the treatment of far-migrated lumbar disc herniation (LDH) is clinically challenging. The aim of this study was to compare the efficacy and safety of interlaminar endoscopic lumbar discectomy (IELD) and interlaminar microscopic lumbar discectomy (IMLD) for the treatment of far-migrated LDH. Materials and Methods We retrospectively analyzed 50 consecutive cases of far-migrated LDH treated by IELD or IMLD. Clinical data and outcomes were assessed before the operation and 1 day and 3, 12, and 24 months after the surgery using the visual analog scale (VAS) and Oswestry disability index (ODI). Modified MacNab criteria were used to evaluate patient satisfaction at the 24-month follow-up. Results A significant reduction in leg pain and improvement in ODI (P<0.01) were observed in both groups after surgery. Lower back pain (LBP) was reduced at 24 months postsurgery in the IELD group (P<0.05) but not in the IMLD group (P>0.05). There were significant intergroup differences in VAS LBP score at 1 day and 24 months postsurgery (p=0.01 and 0.02, respectively) and in ODI at 24 months (p=0.03). The rate of excellent or good outcome was 90.32% with IELD and 78.95% with IMLD (p=0.55). Hospital stay and time to ambulation were shorter in the IELD group than in the IMLD group, but the former had a longer operative time (p<0.01). Low and comparable complication rates were reported in the IELD (16.13%) and IMLD (10.53%) groups (p=0.70). Conclusion Both IELD and IMLD achieve favorable clinical results in the treatment of far-migrated LDH, with only minor complications. Compared to IMLD, LBP was significantly reduced with IELD presumably because it involved less trauma.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endoscopic and Microscopic Interlaminar Discectomy for the Treatment of Far-Migrated Lumbar Disc Herniation: A Retrospective Study with a 24-Month Follow-Up

Fei¹,

Ren²,

Ye³

et al. 2021

JPR

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“…Transforaminal and translaminar approach PELD has been used in the treatment of various types of lumbar disc herniation (LDH) with good clinical efficacy. 3,4 Studies indicated that the therapeutic effect of endoscopic spinal nucleus pulposus extraction was similar to that of traditional open discectomy. [5][6][7] Some researchers have gradually applied MELD to LDH with high displacement to ensure surgical efficacy and further reduce surgical trauma.…”

Section: Introductionmentioning

confidence: 99%

Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine

Chen¹,

2021

Pak J Med Sci

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Original Article Bin Chen1, Zengfeng Du2 ABSTRACTObjective: To explore the technical points, approach selection and short-term clinical efficacy of PELD through the intervertebral foramina or interlaminar approach in the treatment of highly shifted LDH. Methods: From September 2018 to June 2020, 19 patients with highly shifted LDH were treated with PELD in The First Hospital of Yulin. It included, 10 males and 9 females; aged 34 to 69 years, with an average of 48 years. Thirteen cases were shifted to the caudal side, and six cases were shifted to the head side. The responsible segments included L3/41 cases, L4/511 cases, and L5/S17 cases. All patients had symptoms of low back and leg pain. The Sowerby dysfunction index (ODI) was 63.5%±10.7% before surgery. The visual analogue scale of pain (VAS) was low back pain (5.2±2.1) and leg pain (7.1±2.4). 14 cases used transforaminal approach, and 5 cases used translaminar approach. Results: All cases completed the operation successfully, the operation time was 60~110min, with an average of 70 minutes. The follow-up time ranged from 6 to 42 months, with an average of 20.8 months. At the last follow-up, ODI was 10.8%±6.8%, VAS back pain score (2.1±1.1) and leg pain score (1.8±0.9). Compared with preoperative, ODI and VAS scores were significantly decreased (P<0.05). The results of Mac Nab method were 14 excellent, four good, and one fair. During the follow-up period, one patient’s leg pain symptoms recurred seven days after operation. No further hernia was found under intervertebral foramen. The symptoms disappeared after two weeks of symptomatic treatment such as swelling and analgesia, and he was discharged. No perioperative complications such as infection and nerve root injury occurred. Conclusion: When PELD is used to treat high-displacement LDH, the choice of transforaminal approach or interlaminar approach needs to be personalized according to the LDH segment and the direction of displacement. KEYWORDS: Spinal Surgery, Spinal Endoscopic Imaging, Inter Laminar Spine, Nucleus Pulposus Removal. doi: https://doi.org/10.12669/pjms.37.6-WIT.4880How to cite this:Chen B, Du Z. Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine. Pak J Med Sci. 2021;37(6):1667-1671. doi: https://doi.org/10.12669/pjms.37.6-WIT.4880 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…15,16 With the development of surgical equipment and techniques, several previous studies focused on the effectiveness and outcomes of some novel minimally invasive surgical approaches for migrated LDH. [17][18][19] However, we are not aware of any previous study evaluating the surgical outcomes of MIS-TLIF for highly migrated LDH. Therefore, the purpose of the current study was to describe MIS-TLIF for a one-segmental highly migrated LDH case series and assess its surgical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for Highly Migrated Lumbar Disc Herniation

Wang

2021

JPR

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Objective To describe minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for highly migrated lumbar disc herniation (LDH) and assess its clinical outcomes. Patients and Methods This research retrospectively assessed 25 patients who were diagnosed with one-segmental highly migrated LDH and underwent MIS-TLIF in Peking University First Hospital from June 2015 to September 2019. Demographic data, perioperative parameters, complications, recurrence, and surgical outcomes were assessed. Results Twelve males and 13 females, with a mean age of 56.68 years old, were involved and the follow-up period was at least one year. The mean operation time was 222.16 minutes, the mean intraoperative hemorrhage was 250.00 mL, and the mean post-operative hospitalization was 5.76 days. The improvements in visual analog scale (VAS) and Oswestry disability index (ODI) were statistically significant. In addition, based on the MacNab criteria, 22 patients (88.0%) acquired satisfactory (good or excellent) results. One patient underwent post-operative epidural hematoma and recovered after evacuation of the hematoma. No recurrence was found. Conclusion MIS-TLIF is safe and effective and it can provide satisfactory clinical outcomes for highly migrated LDH.

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Percutaneous Endoscopic Lumbar Discectomy (PELD) via a Transforaminal and Interlaminar Combined Approach for Very Highly Migrated Lumbar Disc Herniation (LDH) Between L4/5 and L5/S1 Level

Cited by 15 publications

References 15 publications

Endoscopic and Microscopic Interlaminar Discectomy for the Treatment of Far-Migrated Lumbar Disc Herniation: A Retrospective Study with a 24-Month Follow-Up

Endoscopic and Microscopic Interlaminar Discectomy for the Treatment of Far-Migrated Lumbar Disc Herniation: A Retrospective Study with a 24-Month Follow-Up

Neurological safety of spinal surgery for nucleus pulposus removal under spinal endoscopic imaging guided by inter laminar spine

Surgical Outcomes of Minimally Invasive Transforaminal Lumbar Interbody Fusion for Highly Migrated Lumbar Disc Herniation

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