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Chau AMT, Lerch A, Waser B, Green L, Papacostas J, Tsahtsarlis A, McMillen J, Campbell R, Wood M, Amato D. Minimally invasive far lateral tubular microdiscectomy: surgical technique and case series of 176 patients. 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 2024:10.1007/s00586-024-08450-z. [PMID: 39155332 DOI: 10.1007/s00586-024-08450-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/03/2024] [Accepted: 08/12/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Far lateral (extraforaminal) disc herniations comprise approximately 10% of symptomatic lumbar disc herniations. They represent operative challenges due to accessibility and surgical unfamiliarity. Surgical strategies in the past have included open discectomy and posterior lumbar interbody fusion. Tubular microdiscectomies have gained traction due to their minimally invasive advantages, including reduced morbidity, pain and length of hospital stay. METHODS We report our retrospective single institution consecutive case series of tubular far lateral microdiscectomies. One hundred and seventy-six patients were operated on over an eight-year period. Clinical outcomes were assessed after institutional ethics approval. We additionally describe our surgical technique with an illustrative video case. RESULTS Over a mean follow-up of 21 weeks, 77% of patients had good or excellent clinical outcomes according to the MacNab criteria. 12% of patients underwent reoperation at the index level for symptom recurrence or persistence. Mean length of hospital stay was 1.3 days. There was a 1% rate of both postoperative haematoma and infection. Mean operation duration was 86 minutes. CONCLUSION This case series represents the largest currently reported in the literature. Minimally invasive microdiscectomies performed through tubes allow for precise localisation, reduced tissue disruption and favourable clinical outcomes. Our results appear consistent with a review of the literature, demonstrating the safety and efficacy of this approach.
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Affiliation(s)
| | - Aaron Lerch
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia.
- The University of Queensland, Brisbane, Australia.
| | - Barton Waser
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
| | - Lauren Green
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
| | - Jason Papacostas
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
| | - Antonio Tsahtsarlis
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
| | - Jason McMillen
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
| | - Robert Campbell
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
| | - Martin Wood
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
| | - Damian Amato
- Brisbane Clinical Neuroscience Centre, Mater Hospital, South Brisbane, QLD, Australia
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Lin L, Ke ZY, Chu L, Cheng Y, Zhao GS, Zhong D, Cai X, Chen XL. Full-endoscopic lumbar discectomy via lateral superior articular process approach for treating far lateral lumbar disc herniation: a retrospective study and technical note. INTERNATIONAL ORTHOPAEDICS 2023; 47:2843-2850. [PMID: 37632529 DOI: 10.1007/s00264-023-05937-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/10/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE This study aims to evaluate the efficacy and safety of the full-endoscopic lumbar discectomy (FELD) via lateral superior articular process (LSAP) approach and full-endoscopic transforaminal discectomy (FETD) for treating far lateral lumbar disk herniation (FFLDH). METHODS From January 2020 to June 2022, patients who were diagnosed as FLLDH underwent the FELD via LSAP approach or FETD. The operation time, estimated blood loss, length of hospital stays, and complications were recorded. The visual analog scale (VAS) for back pain, VAS for leg pain, and the Oswestry Disability Index (ODI) scores was measured during preoperative and postoperative follow-up. RESULTS Thirty-two patients were enrolled in this study, of which 12 patients were treated with the FELD via LSAP approach (LSAP-FELD group) and 20 patients underwent FETD (FETD group). The LSAP-FELD group exhibited significantly shorter operation times and hospital stays compared to the FETD group, while no statistically significant differences were observed in intraoperative blood loss and complication rates. There were no significant differences in the VAS for back pain, the VAS for leg pain, and the ODI score between the two groups preoperatively and three days, three months, and the last follow-up postoperatively. CONCLUSIONS Both the FELD via LSAP approach and FETD have demonstrated favourable clinical efficacy in the treatment of FLLDH. Notably, the FELD via LSAP approach shows the advantages of shorter operation time and hospital stays.
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Affiliation(s)
- Lu Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
- Pain Medical Center, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Zhen-Yong Ke
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Lei Chu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
- Pain Medical Center, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Yun Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Guo-Sheng Zhao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Dian Zhong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Xin Cai
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China
| | - Xiao-Lin Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, No.76, Linjiang Road, Yuzhong District, Chongqing, 400010, China.
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An J, Zhang J, Yu T, Wu J, Nie X, He T, Yun Z, Liu R, Xue W, Qi L, Li Y, Liu Q. A Retrospective Comparative Study of Modified Percutaneous Endoscopic Transforaminal Discectomy and Open Lumbar Discectomy for Gluteal Pain Caused by Lumbar Disc Herniation. Front Surg 2022; 9:930036. [PMID: 35813040 PMCID: PMC9257256 DOI: 10.3389/fsurg.2022.930036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 12/29/2022] Open
Abstract
IntroductionThis study aimed to demonstrate the safety and effectiveness of modified percutaneous endoscopic transforaminal discectomy (PETD) in the surgical management of single-segment lumbar disc herniation (LDH) gluteal pain and to determine whether it provides a better clinical outcome than open lumbar discectomy (OD).MethodsA retrospective analysis of patients treated with modified PETD and OD for gluteal pain in LDH from January 2015 to December 2020 was conducted. Sample size was determined using a priori power analysis. Demographic information, surgical outcomes including procedure time (minutes), intraoperative blood loss (mL), hospital days, costs (RMB), fluoroscopy shots, recurrence and complications, etc., were recorded and analyzed. Prognostic outcomes were assessed using the visual analog scale (VAS), the Oswestry Disability Index (ODI), the Japanese Orthopedic Association Score (JOA) and modified MacNab criteria. The preoperative and postoperative VAS, ODI and JOA scores were recorded by two assistants. When the results were inconsistent, the scores were recorded again by the lead professor until all scores were consistently recorded in the data. MRI was used to assess radiological improvement and all patients received follow-ups for at least one year.ResultsThe sample size required for the study was calculated by a priori analysis, and a total of 72 participants were required for the study to achieve 95% statistical test power. A total of 93 patients were included, 47 of whom underwent modified PETD, and 46 of whom underwent OD. In the modified PETD intragroup comparison, VAS scores ranged from 7.14 ± 0.89 preoperatively to 2.00 ± 0.58, 2.68 ± 0.70, 2.55 ± 0.69, 2.23 ± 0.81, and 1.85 ± 0.72 at 7 days, 1 month, 3 months, 6 months, and 12 months postoperatively. Patients showed significant pain relief postoperatively (P < 0.01). According to the modified MacNab score, the excellent rate in the PETD group was 89.36%. There was no significant difference compared to the OD group (89.13%, P > 0.05). Complication rates were lower (P > 0.05) but recurrence rates were higher (P > 0.05) in the modified PETD group than in the OD group. The modified PETD group had a faster operative time (P < 0.01), shorter hospital stay (P < 0.01), less intraoperative bleeding (P < 0.01), and less financial burden to the patient (P < 0.01) than the OD group. At 7 days postoperatively, the VAS score for low back pain was higher in the OD group than in the modified PETD group (P < 0.01). The VAS and JOA scores at 1, 3, 6, and 12 months postoperatively were not significantly different between the modified PETD and OD groups (P > 0.05), and the ODI was significantly different at 3 months postoperatively (P < 0.05).ConclusionModified PETD treatment is safe and effective for gluteal pain due to L4/5 disc herniation and has the advantages of a lower complication rate, faster postoperative recovery, shorter length of stay, fewer anesthesia risks and lower cost of the procedure compared with OD. However, modified PETD has a higher recurrence rate.
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Affiliation(s)
- Junyan An
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jun Zhang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tong Yu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Jiuping Wu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Xinyu Nie
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Tao He
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Zhihe Yun
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Rui Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Wu Xue
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Le Qi
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
| | - Yingzhi Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Correspondence: Qinyi Liu Yingzhi Li
| | - Qinyi Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, China
- Correspondence: Qinyi Liu Yingzhi Li
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Li P, Yang F, Chen Y, Song Y. Percutaneous transforaminal endoscopic discectomy for different types of lumbar disc herniation: A retrospective study. J Int Med Res 2021; 49:3000605211055045. [PMID: 34706589 PMCID: PMC8558600 DOI: 10.1177/03000605211055045] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective To introduce the concept of ‘nerve root as the core’ and to investigate the surgical procedure and curative effect of percutaneous translaminar endoscopic discectomy (PTED) surgery in the treatment of different types of lumbar disc herniation (LDH). Methods This retrospective study analysed the clinical data from patients with LDH that underwent single-segment PTED surgery. They were divided into three groups based on LDH location: central canal zone group, lateral recess zone group and foraminal/far lateral zone group. Different working cannula placement methods were used for the different types of LDH. All patients were followed for at least 12 months. Clinical and follow-up data were compared between the three groups. Results A total of 130 patients were enrolled in the study: 44 (33.8%) in the central canal zone group, 72 (55.4%) in the lateral recess zone group and 14 (10.8%) in the foraminal/far lateral zone group. All three groups of patients achieved good postoperative results. The improvements in leg pain and disability were most marked in the first postoperative month in all three groups. Conclusion PTED achieved adequate decompression for different types of LDH. The concept of ‘nerve root as the core’ facilitated the accurate placement of the working cannula.
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Affiliation(s)
- Pengfei Li
- Department of Graduate School, Chengde Medical University, Chengde, Hebei Province, China.,Department of Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Fengkai Yang
- Department of Graduate School, Chengde Medical University, Chengde, Hebei Province, China.,Department of Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Ying Chen
- Department of Graduate School, Chengde Medical University, Chengde, Hebei Province, China.,Department of Rehabilitation, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
| | - Youxin Song
- Department of Orthopaedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei Province, China
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Ouyang ZH, Tang M, Li HW, Zou MX, Li XL, Wang WJ, Yan YG. Full-Endoscopic Foraminoplasty Using a Visualized Bone Reamer in the Treatment of Lumbar Disc Herniation: A Retrospective Study of 80 Cases. World Neurosurg 2021; 149:e292-e297. [PMID: 33609764 DOI: 10.1016/j.wneu.2021.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/07/2021] [Accepted: 02/08/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous endoscopic lumbar discectomy (PELD) has been widely used, before which foraminoplasty is necessary to widen the foramen for subsequent procedures. However, the learning curve of this technology is high, as the use of traditional reamers requires repeated intraoperative fluoroscopy. We sought to compare the clinical outcomes by using the visualized and traditional reamers in PELD foraminoplasty for the treatment of lumbar disc herniation. METHODS Eighty patients with lumbar disc herniation who were treated with PELD between 1 January 2017 and 1 January 2019 were retrospectively reviewed. The patients were randomly divided into 2 groups (40 patients in the Visualized Bone Reamer group) and (40 patients in the Traditional Bone Reamer group). Intraoperative fluoroscopy time, cannulation introduction time, visual analog scale, and Macnab criteria score were compared between the 2 groups. RESULTS The mean follow-up durations were 17.41 ± 1.47 and 18.37 ± 1.69 months in the visualized and traditional groups, respectively. The average cannulation introduction time and intraoperative fluoroscopy times in the visualized group is significantly lower than those in traditional group (29.20 ± 3.31 vs. 39.85 ± 3.98 minutes, P < 0.001; and 12.30 ± 2.38 vs. 20.65 ±3.51 seconds, P < 0.001, respectively). One patient in the traditional group required reoperation, and no complications occurred in the visualized group. There were no severe durotomies or vascular or visceral injuries. CONCLUSIONS Full-endoscopic foraminoplasty using a visualized reamer is safe and effective and can decrease intraoperative fluoroscopy time in PELD.
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Affiliation(s)
- Zhi-Hua Ouyang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ming Tang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Hong-Wei Li
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Ming-Xiang Zou
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Xue-Lin Li
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Wen-Jun Wang
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China
| | - Yi-Guo Yan
- Department of Spine Surgery, The First Affiliated Hospital, University of South China, Hengyang, China.
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Zhang Y, Chen J, Xie H, Li K, Wang Y, Chen Q, Jiang C, He J, Fu N. Comparison of the application value of two commonly used minimally invasive spinal surgery in the treatment of lumbar disc herniation. Exp Ther Med 2021; 21:299. [PMID: 33717242 DOI: 10.3892/etm.2021.9730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 11/25/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the study was to compare the application value of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) in the treatment of lumbar disc herniation (LDH). From January 2017 to July 2018, 108 LDH patients undergoing surgical treatment in our hospital were collected and divided into PTED group (treated with PTED, n=50) and MED group (treated with MED, n=58). The operation parameter index level, complications, recurrence and pain score (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association Scale (JOA) were compared between the two groups. VAS, ODI and JOA scores of the two groups were significantly decreased after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Complications and recurrence of the two groups were similar (P>0.05). MED was superior to PTED in the number of intraoperative fluoroscopy and operation time, while PTED was superior to MED in intraoperative blood loss, incision length, length of hospital stay and bed rest time (P<0.05). Both PTED and MED can effectively treat LDH. Referring to clinical data, PTED may be the first choice for LDH treatment.
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Affiliation(s)
- Yingbo Zhang
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jinping Chen
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Haiyang Xie
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Kui Li
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Ye Wang
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Qian Chen
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Cheng Jiang
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jiangtao He
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Nenggao Fu
- Department of Orthopaedics, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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