Trans-Sacral Epiduroscopic Laser Decompression for Symptomatic Lumbar Disc Herniation: A Preliminary Case Series

Lee, Sung Ho; Lee, Sang-Ho; Lim, Kang Taek

doi:10.1089/pho.2015.4000

Cited by 34 publications

(46 citation statements)

References 8 publications

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“…Our study confirmed that a SELD-assisted, 1,414-nm Nd:YAG laser can effectively treat lumbar discal cyst 7,12,14) . However, this study had some limitations.…”

Section: Macnabs: Outcome Assesment Of Patients Satisfactionsupporting

confidence: 78%

“…An in vivo study reported that 6-Watt delivery of the 1,414-nm Nd:YAG laser and the addition of an epiduroscope led to lower heat delivered to the surrounding ablated tissue, deeper tissue penetration, and increased target accuracy. This reduced the risk of thermal injury and made the 1,414-nm Nd:YAG laser safe for use in humans 12,14) .…”

Section: Macnabs: Outcome Assesment Of Patients Satisfactionmentioning

confidence: 99%

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Trans-Sacral Epiduroscopic-Assisted 1,414-nm Nd:YAG Laser Decompression for Lumbar Discal Cyst: A Report of 9 Cases

Yudoyono

Ji²,

Lee³

et al. 2018

J Minim Invasive Spine Surg Tech

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Prevalence of lumbar discal cyst is very low, it can cause low back pain and radiating leg pain when present. Currently, trans-sacral epiduroscopic-assisted, 1,414-nm Nd:YAG laser decompression (SELD) is commonly used for spinal pathologies. However, the use of the laser for spinal procedures can be limited due to the risk of thermal injury. We reviewed nine consecutive patients who underwent SELD ablation for discal cyst between 2014 and 2015. Each patient underwent diagnostic imaging, including simple radiographs, computed tomography with discography, and magnetic resonance imaging (MRI). Pain relief and clinical outcome assessment of patient satisfaction was the primary outcome measure. All patients presented with back pain and unilateral radiating pain. The discal cyst was located in the lumbar region in all patients. Preoperative MRI showed a connection between the cyst and the involved intervertebral disc. All patients obtained immediate relief of symptoms after the discal cyst was treated with a SELD-assisted, 1,414-nm Nd:YAG laser. The mean visual analogue scale (VAS) for back pain was 7.89±0.78 preoperatively, 1.67±1.50 at the 1-month follow up, and 0.38±0.5 at the final follow up (p< 0.01). All patients obtained excellent or good outcomes according to the modified MacNab's criteria. There were no complications. These cases demonstrated that trans-sacral, epiduroscopic-assisted, 1,414nm Nd:YAG laser decompression was a safe, viable, and efficacious option for treating lumbar discal cyst because it lowers the risk of muscle injury and can be performed under local anesthesia.

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“…Our study confirmed that a SELD-assisted, 1,414-nm Nd:YAG laser can effectively treat lumbar discal cyst 7,12,14) . However, this study had some limitations.…”

Section: Macnabs: Outcome Assesment Of Patients Satisfactionsupporting

confidence: 78%

Section: Macnabs: Outcome Assesment Of Patients Satisfactionmentioning

confidence: 99%

Trans-Sacral Epiduroscopic-Assisted 1,414-nm Nd:YAG Laser Decompression for Lumbar Discal Cyst: A Report of 9 Cases

Yudoyono

Ji²,

Lee³

et al. 2018

J Minim Invasive Spine Surg Tech

View full text Add to dashboard Cite

show abstract

“…By comparison, accessing a centrally located disc herniation is difficult using a traditional open approach due to the need to interrupt the thecal sac and nerve root. As such, spine surgeons are increasingly interested in the application of SELD in these cases as the technique provides a similar procedural pathway as percutaneous epidural neuroplasty (PEN), as well as relying on the same anatomical references [6]. Although the use of SELD is increasing, the types of complications, as well as the rate of these complications, have not been clearly established.…”

Section: Introductionmentioning

confidence: 99%

Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study

et al. 2017

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BackgroundTrans-sacral epiduroscopic lumbar decompression (SELD) is an emerging procedure for the treatment of lumbar disc herniation (LDH), with favorable outcomes having been reported. However, the complications associated with SELD have not been comprehensively evaluated to date. Therefore, the aim of our study was to describe the incidence rate, types, and characteristics of complications following SELD and management outcomes.MethodsRetrospective analysis of the surgical and clinical outcomes for 127 patients (average age, 42.2 ± 15.2 years) who underwent SELD for LDH at L2-3, L3-4, L4-5, and/or L5-S1, performed by a single experienced spine surgeon at a single center, between January 2015 and April 2017, was conducted.ResultsAll procedures were successful, with a mean follow-up of 12.3 ± 2.3 months. Complications were identified in 8 patients (6.3%), including 3 cases of incomplete decompression (2.4%), 2 cases of recurrent disc herniation (1.6%), and one case each of hematoma, dural tearing, and subchondral osteonecrosis (0.8%). Among these cases with complications, only 2 cases with incomplete decompression and one case with recurrent LDH did not improve with conservative treatment and required re-operation using an open approach. The rate of complications decreased from 12.6% when considering only the first 50 cases to 2.6% for cases 51–127.ConclusionsIncomplete decompression, recurrent herniation, epidural hematoma, dural tear, and subchondral osteonecrosis were identified as complications of SELD, although the overall rate of complications was low. Practice with the procedure and careful patient selection can lower the risk of complications.

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“…The trans-sacral epiduroscopic laser decompression (SELD) technique has been widely used as an out-patient departmentbased procedure that can relieve symptoms without using general anesthesia in patients experiencing lumbar herniated nucleus pulposus (HNP) 6,9,11) . Endoscopy is performed through the sacral hiatus into the epidural space, and the disc can be decompressed by cauterizing the disc using laser, while directly exploring the disc at the affected area pressing the sac 10) .…”

Section: Introductionmentioning

confidence: 99%

Minimally Invasive Irrigation for Lumbar Spinal Epidural Abscess using a Trans-Sacral Epiduroscopic Laser Decompression Catheter

Hong

Lee

Moon

et al. 2018

J Minim Invasive Spine Surg Tech

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We describe a case of a spinal epidural abscess that was successfully treated with minimally invasive irrigation using trans-sacral epiduroscopic laser decompression (SELD) catheter. A 66-year-old man experienced aggravating right leg pain and lower back pain for 1 month despite receiving several pain blocks at a local hospital. Magnetic resonance imaging scans showed annular fissure and bulging disc at the L4/5 level. Therefore, we decided to treat the L4/5 lesion using SELD. Laboratory studies demonstrated leukocytosis and elevated C-reactive protein level. However, we did not pay attention to the abnormal laboratory values before SELD. During SELD, we found a yellowish epidural abscess and pus drainage. Therefore, we irrigated the epidural abscess using an SELD catheter. His low back pain was relieved dramatically immediately after the procedure. The spinal epidural abscess completely resolved after 20 days of antibiotic treatment. Minimally invasive irrigation and drainage using a SELD catheter and intravenous antibiotic therapy are helpful for the treatment of spinal epidural abscess.

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Trans-Sacral Epiduroscopic Laser Decompression for Symptomatic Lumbar Disc Herniation: A Preliminary Case Series

Cited by 34 publications

References 8 publications

Trans-Sacral Epiduroscopic-Assisted 1,414-nm Nd:YAG Laser Decompression for Lumbar Discal Cyst: A Report of 9 Cases

Trans-Sacral Epiduroscopic-Assisted 1,414-nm Nd:YAG Laser Decompression for Lumbar Discal Cyst: A Report of 9 Cases

Complications of lumbar disc herniations following trans-sacral epiduroscopic lumbar decompression: a single-center, retrospective study

Minimally Invasive Irrigation for Lumbar Spinal Epidural Abscess using a Trans-Sacral Epiduroscopic Laser Decompression Catheter

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