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Endoscopic Unilateral Laminotomy with Bilateral Discectomy Using Biportal Endoscopic Approach: Technical Report and Preliminary Clinical Results. World Neurosurg 2020; 137:31-37. [PMID: 32028006 DOI: 10.1016/j.wneu.2020.01.190] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND Bilateral or huge disc herniations cause bilateral radiculopathy and severe lower back pain. In such cases, a bilateral discectomy may be required to resolve the radicular pain in both legs. We attempted a surgical technique involving bilateral lumbar discectomy via a unilateral approach using a percutaneous biportal endoscopic technique. The purpose of the present study was to describe our surgical technique and investigate the clinical outcomes in symptomatic bilateral lumbar disc herniation. METHODS Eleven patients with bilateral disc herniation of the L4-L5 or L5-S1 segments were surgically treated using the percutaneous biportal endoscopic approach. Biportal endoscopic unilateral laminotomy with bilateral discectomy was performed in all patients. Postoperative magnetic resonance imaging was performed 1 day after surgery, and the clinical parameters were investigated preoperatively and postoperatively. RESULTS All enrolled patients were successfully treated by biportal endoscopic bilateral discectomy via a unilateral approach. Surgery was performed at the L4-L5 level in 1 patient and the L5-S1 level in 10 patients. The mean operative time was 67.5 ± 13.1 minutes. A visual analog scale of leg pain and the Oswestry disability index showed significant improvement after surgery (P < 0.05). CONCLUSION Endoscopic unilateral laminotomy with bilateral discectomy using the percutaneous biportal endoscopic approach could be an effective and alternative treatment of symptomatic bilateral herniated disc disease affecting L4-L5 or L5-S1 segments.
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Li K, Gao K, Zhang T, Lv CL. Comparison of percutaneous transforaminal endoscopic lumbar discectomy through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms: technical notes and a prospective randomized study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 29:1724-1732. [PMID: 31734805 DOI: 10.1007/s00586-019-06210-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 10/16/2019] [Accepted: 11/07/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE In this study, the authors described the technical notes of percutaneous transforaminal endoscopic lumbar discectomy (PTELD) through unilateral approach and compared PTELD through unilateral versus bilateral approach for L3/4 or L4/5 lumbar disc herniation with bilateral symptoms. METHODS A prospective randomized clinical study was performed from June 2014 to October 2016. A total of 71 patients with lumbar disc herniation (L3/4 or L4/5) and bilateral symptoms were divided randomly into Unilateral-Approach group (n = 35) or Bilateral-Approach group (n = 36). Operation time, blood loss, intraoperative fluoroscopy and recurrences were recorded and analyzed statistically. Visual Analogue Scale scores, Oswestry Disability Index and the MacNab standard were used to analyze the clinical outcomes of the two groups. RESULTS The baseline data of the two groups were statistically similar. There was significant postoperative improvement in VAS and ODI scores in both the groups, and clinical outcomes are comparable according to the MacNab standard. However, VAS score of back pain at 1 day after surgery in Unilateral-Approach group was significantly lower than that in Bilateral-Approach group (P < 0.05). Moreover, operation time and cumulative time of intraoperative fluoroscopy of Unilateral-Approach group were significantly shorter than that of Bilateral-Approach group (P < 0.05). CONCLUSION For L3/4 or L4/5 LDH with bilateral symptoms, PTELD through unilateral approach is effective, with advantage of shorter operation time, shorter cumulative time of intraoperative fluoroscopy and milder postoperative short-term back pain compared to bilateral approach. These slides can be retrieved under Electronic Supplementary Material.
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Affiliation(s)
- Kang Li
- Department of Spine Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China.,Department of Spine Surgery, Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China
| | - Kai Gao
- Department of Joint Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China
| | - Tao Zhang
- Department of Spine Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China.,Department of Spine Surgery, Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China
| | - Chao-Liang Lv
- Department of Spine Surgery, Jining No. 1 People's Hospital, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China. .,Department of Spine Surgery, Affiliated Jining No. 1 People's Hospital of Jining Medical University, Jining Medical University, 6 Jiankang Road, Jining, 272000, Shandong Province, People's Republic of China.
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A History of Endoscopic Lumbar Spine Surgery: What Have We Learnt? BIOMED RESEARCH INTERNATIONAL 2019; 2019:4583943. [PMID: 31139642 PMCID: PMC6470418 DOI: 10.1155/2019/4583943] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 02/04/2019] [Indexed: 12/30/2022]
Abstract
The new development and finally the general acceptance of surgical techniques among the worldwide surgical community sometimes create fascinating stories. This is also true for the history of endoscopic lumbar spine surgery. In the last 100 years there was a “natural” evolution of surgical techniques with continuous improvement and “refinement” of lumbar decompression techniques towards less invasive operations with the final “endpoint” of microsurgery. However the application of percutaneous, image-guided, and endoscopic technologies has revolutionized minimally invasive surgery. This article describes the history of endoscopic lumbar spine surgery and its major milestones and protagonists which have helped to make endoscopic lumbar spine surgery “disruptive” minimally invasive surgical technology which has changed the world of lumbar decompression surgery. “The past is the mother of the future” Henri Cartier Bresson, French Photographer, 1908-2004
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Kim M, Kim HS, Oh SW, Adsul NM, Singh R, Kashlan ON, Noh JH, Jang IT, Oh SH. Evolution of Spinal Endoscopic Surgery. Neurospine 2019; 16:6-14. [PMID: 31618807 PMCID: PMC6449828 DOI: 10.14245/ns.1836322.161] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 02/25/2019] [Indexed: 12/20/2022] Open
Abstract
Innovations in the development of endoscopic spinal surgery were classified into different generations and reviewed. Future developments and directions for endoscopic spinal surgery were discussed. Surgical therapy for spinal disease has been gradually changing from traditional open surgery to minimally invasive spinal surgery. Recently, endoscopic spinal surgery, which initially was limited to the treatment of soft tissue lesions, has expanded to include other aspects of spinal disease and good clinical results have been reported. As the paradigm of spinal surgery shifts from open surgery to endoscopic surgery, we discussed the evolution of endoscopic spine surgery in our literature review. Through this description, we presented possibilities of future developments and directions in endoscopic spine surgery.
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Affiliation(s)
- Manyoung Kim
- Department of Orthopaedic Surgery, The Leon Wiltse Memorial Hospital, Anyang, Korea
| | - Hyeun-Sung Kim
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Sung Woon Oh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Ravindra Singh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | | | - Jung Hoon Noh
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Il Tae Jang
- Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea
| | - Seong Hoon Oh
- Department of Neurosurgery, Nanoori Incheon Hospital, Incheon, Korea
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Transforaminal Endoscopic Decompression in Lumbar Spondylolisthesis-Background and Perspectives. World Neurosurg 2018; 118:243-245. [PMID: 30031959 DOI: 10.1016/j.wneu.2018.07.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
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