Systematic review of microendoscopic discectomy for lumbar disc herniation

Smith, Nicholas A.; Masters, James; Jensen, Cyrus D.; Khan, Almas; Sprowson, Andrew P.

doi:10.1007/s00586-013-2848-8

Cited by 46 publications

(28 citation statements)

References 15 publications

(37 reference statements)

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“…Whether the theoretical advantages of transforaminal endoscopic (TED) surgery for symptomatic lumbar disc herniation are borne out by patient outcomes remains unclear. A systematic review has highlighted a paucity of evidence for the TED technique [9], in comparison to data now available in respect of microendoscopic approaches [10,11]. In view of the increasing use of transforaminal approaches to the spine, there is clearly a need for high-quality randomised controlled trials (RCTs) to determine whether TED is as effective as traditional microdiscectomy.…”

Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

2016

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Purpose Transforaminal endoscopic discectomy (TED) minimises paraspinal muscle damage. The aim of this trial was to compare clinical outcomes of TED to Microdiscectomy (Micro). Methods 143 patients, age 25-70 years and \115 kg, with single level lumbar prolapse and radiculopathy, were recruited and randomised. 70 received TED under conscious sedation and 70 Micro under general anaesthesia. Oswestry Disability Index (ODI), visual analogue scores (VAS) of back and leg pain, and Short Form Health Survey indices (SF-36) were measured preoperatively and at 3, 12 and 24 months. Results All outcome measures improved significantly in both groups (p \ 0.001). Affected side leg pain was lower in the TED group at 2 years (1.9 ± 2.6 vs 3.5 ± 3.1, p = 0.002). Hospital stay was shorter following TED (0.7 ± 0.7 vs 1.4 ± 1.3 days, p \ 0.001). Two Micro patients and five TED patients required revision giving a relative risk of revision for TED of 2.62 (95% CI 0.49-14.0). Conclusions Functional improvements were maintained at 2 years in both groups with less ongoing sciatica after TED. A greater revision rate after TED was offset by a more rapid recovery.

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Section: Introductionmentioning

confidence: 99%

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

2016

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“…10,17,34,42,43 Microendoscopic discectomy (MED) uses a tubular transmuscular working channel (16-20 mm) to approach the spine coupled with an endoscope to enable visualization. 8,9,31,33,35,44,51,52,54,55 The same muscle-splitting device can also be used with the microscope to perform a minimally invasive microdiscectomy. [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.…”

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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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“…Систематический обзор N. Smith с соавтора-ми выявил четыре рандомизированных контро-лируемых исследования, посвященных срав-нению микроэндоскопической дискэктомии и микродискэктомии [35]. значимых различий в течении раннего послеоперационного перио-да, клинических результатах, частоте рецидивов и количестве осложнений выявлено не было.…”

Section: исходы леченияunclassified

Outcomes of Transforaminal Endoscopic Discectomy for Lumbosacral Disc Herniation

Волков

Карабаев

Пташников

et al. 2017

Traumatology and Orthopedics of Russia

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Introduction. Lumbar disc herniation is a frequent pathology and surgical target. Endoscopic discectomy becomes more popular due to minimally invasive surgical technique. There is a deficit of scientific papers dedicated to analysis of potential for endoscopic discectomy depending on the specifics of spinal anatomy and degenerative changes.The purpose of the study was to evaluate the efficacy of transforaminal endoscopic discectomy (TED) in comparison with microdiscectomy (MD) and to specify factors determining complications and failures.Materials and methods. The authors performed randomized controlled study where main group of patients included data on prospective examination of 101 patients after TED procedure for lumbar intervertebral disc herniation. Age of patients ranged from 19 to 81 years with average of 41,4±12,6 years. Control group included data of retrospective examination of 153 patients that were operated by the same surgeon in the period from 201 till 2104 with microdiscectomy procedure. Age of patients ranged from 18 to 77 years with average of 47,8±11,3 years. Inclusion criteria were as follows: surgical procedure at the same level of the primary intervertebral herniation. Exclusion criteria were: degenerative spinal canal stenosis, spondylolisthesis, spine deformity.Results. Clinical outcomes after TED demonstrated no difference from MD procedure. No factors of significant influence on outcomes after surgical procedure were observed. The main group was characterized by more cases of revisions and conversions of endoscopic into open procedures (13,9%) which was related to mistakes in transforaminal approach due to features of intervertebral joints and foramina anatomy resulting in impossibility to achieve adequate spinal canal decompression.Conclusion. Transforaminal endoscopic discectomy is an effective and safe method of lumbar intervertebral herniation treatment. Complications and failures during learning curve of endoscopic procedure are associated with technique drawbacks as well as with mistakes in planning and performing the approach. Congenital alignment of lumbar spine with specific patterns of facets and foramina anatomy dictate technical difficulties with transforaminal approach.

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Systematic review of microendoscopic discectomy for lumbar disc herniation

Cited by 46 publications

References 15 publications

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

A randomised controlled trial of transforaminal endoscopic discectomy vs microdiscectomy

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Outcomes of Transforaminal Endoscopic Discectomy for Lumbosacral Disc Herniation

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