Dataset Information

Survey research of patient's preference on choosing microscopic or endoscopic spine surgery for lumbar discectomy.

ABSTRACT:

Background

There are several surgical methods of lumbar discectomy which provide the similar clinical outcomes. There is no clear evidence for how to select the procedures. To better understand the patient's opinion and decision process in the selection of surgical methods between microscopic lumbar discectomy (MLD) and endoscopic lumbar discectomy (ELD).

Methods

A cross-sectional survey study. Summary information sheet was created by reviewing the comparative literatures, and tested for quality and bias. Participants read the summary information sheet then were asked to complete the anonymous questionnaire.

Results

Seventy-six patients (71%) of patients who had no experience in lumbar discectomy selected ELD while 31 patients (29%) selected MLD. There were significant differences of score between patients who selected MLD and ELD in this group for wound size, anesthetic method, operative time, blood loss and length of stay (P< 0.05). In patients who had experience in discectomy group, 22 patients (76%) who underwent MLD still selected MLD if they could select surgical methods again for themselves, while 24 patients (96%) who underwent ELD still selected ELD if they could select again. The most important factor in patients who selected MLD was outcomes of treatment. The most important factor in patients who selected ELD was wound size. There were significant differences of scores between patients who selected MLD and ELD in this group for wound size, anesthetic method, operative time, complication, cost and length of stay (P< 0.05).

Conclusions

About two thirds of the participants preferred ELD after reading the summary evidence information. The most important factor in MLD group was outcomes of treatment while the most important factor in ELD group was wound size.

SUBMITTER: Keorochana G

PROVIDER: S-EPMC10079117 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

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Publications

Survey research of patient's preference on choosing microscopic or endoscopic spine surgery for lumbar discectomy.

Keorochana Gun G Kraiwattanapong Chaiwat C Lertudomphonwanit Thamrong T Udomsubpayakul Umaporn U Leelapattana Pittavat P Chanplakorn Pongsthorn P Wannaratsiri Nutthee N Tawonsawatruk Tulyapruek T

PloS one 20230406 4

<h4>Background</h4>There are several surgical methods of lumbar discectomy which provide the similar clinical outcomes. There is no clear evidence for how to select the procedures. To better understand the patient's opinion and decision process in the selection of surgical methods between microscopic lumbar discectomy (MLD) and endoscopic lumbar discectomy (ELD).<h4>Methods</h4>A cross-sectional survey study. Summary information sheet was created by reviewing the comparative literatures, and tes ...[more]

PMID: 37023036

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Project description:BackgroundThe Spine Patient Outcomes Research Trial showed an overall advantage for operative compared with nonoperative treatment of lumbar disc herniations. Because a recent randomized trial showed no benefit for operative treatment of a disc at the lumbosacral junction (L5-S1), we reviewed subgroups within the Spine Patient Outcomes Research Trial to assess the effect of herniation level on outcomes of operative and nonoperative care.MethodsThe combined randomized and observation cohorts of the Spine Patient Outcomes Research Trial were analyzed by actual treatment received stratified by level of disc herniation. Overall, 646 L5-S1 herniations, 456 L4-L5 herniations, and eighty-eight upper lumbar (L2-L3 or L3-L4) herniations were evaluated. Primary outcome measures were the Short Form-36 bodily pain and physical functioning scales and the modified Oswestry Disability Index assessed at six weeks, three months, six months, one year, and two years. Treatment effects (the improvement in the operative group minus the improvement in the nonoperative group) were estimated with use of longitudinal regression models, adjusting for important covariates.ResultsAt two years, patients with upper lumbar herniations (L2-L3 or L3-L4) showed a significantly greater treatment effect from surgery than did patients with L5-S1 herniations for all outcome measures: 24.6 and 7.1, respectively, for bodily pain (p = 0.002); 23.4 and 9.9 for Short Form-36 physical functioning (p = 0.014); and -19 and -10.3 for Oswestry Disability Index (p = 0.033). There was a trend toward greater treatment effect for surgery at L4-L5 compared with L5-S1, but this was significant only for the Short Form-36 physical functioning subscale (p = 0.006). Differences in treatment effects between the upper lumbar levels and L4-L5 were significant for Short Form-36 bodily pain only (p = 0.018).ConclusionsThe advantage of operative compared with nonoperative treatment varied by herniation level, with the smallest treatment effects at L5-S1, intermediate effects at L4-L5, and the largest effects at L2-L3 and L3-L4. This difference in effect was mainly a result of less improvement in patients with upper lumbar herniations after nonoperative treatment.

Project description:BackgroundFenestration discectomy, for symptomatic lumbar disc herniation, is the most common surgical procedure in spine surgery. It can be done by open or microscopic procedures. This study compared the results of fenestration microdiscectomy with open fenestration discectomy in the treatment of symptomatic lumbar disc herniation as a relation to the functional outcome, leg pain, back pain, hospital stay, returns to daily activity, cost, recurrence, reoperation and type of surgery for recurrent disc herniation.Methods60 patients age (29 - 50 years), with L4-L5 disc herniation, are divided randomly into group A- 30 patients underwent an open fenestration discectomy- and group B- 30 patients underwent fenestration microdiscectomy. All patients are assessed at 1 week, 3 months, 6 months, 12 months after surgery for Oswestry disability index and Visual analogue scale for back pain and leg pain and followed up for 4 years.ResultsIn both groups, all patients have minimal disability by Oswestry Disability Index after surgery. There were significant differences between means of post-operative Visual Analogue Scale for back pain between these two groups after 1 week (3.7 in group A versus 2.2 in group B) (t = 13.28, P = < 0.001*) and after 3 months (1.73 in group A versus 0.43 in group B) (t = 10.54, P = < 0.001*). There were no significant differences between two groups regarding post-operative VAS for leg pain, recurrence (5 patients in group A versus 4 patients in group B) and reoperation rate (2 patients in each group). There were significant differences between means of length of hospital stay (2.10 in group A versus 1.06 in group B) (P < 0.001), time of returning to daily activities (7.33 in group A versus 4.03 in group B) (P < 0.001) and cost of surgery (1996.66 in group A versus 3003.3 in group B) (P < 0.001).ConclusionUse of microscope in fenestration discectomy for treatment of symptomatic lumbar disc herniation can achieve the same goals of open fenestration regarding nerve root decompression and relief of leg pain with advantage of less back pain, less hospital staying and early return to daily activities with disadvantage of more cost with the use of microscope. With 4 years follow up, there was no significant deference in rate of recurrence and reoperation with the use of microscope but we found that type of surgery for recurrent cases may be less invasive if microscope was used in primary surgery.Trial registrationNCT, NCT04112485. Registered 30 September 2019 - Retrospectively registered, https://clinicaltrials.gov/NCT04112485.

Project description:Background:Percutaneous endoscopic transforaminal discectomy (PETD) is regarded as a viable alternative option for upper lumbar disc herniation (LDH). However, few studies have evaluated PETD for upper LDH, and no study has compared the advantages of endoscopic procedures versus conventional surgery. The present study was aimed at comparing the surgical outcome and safety of PETD versus conventional open lumbar discectomy in the treatment of upper LDH. Methods:Data from 42 patients treated for upper LDH from July 2015 to July 2018 were retrospectively analyzed, including 21 patients treated with PETD (PETD group) and 21 patients treated with conventional posterior lumbar discectomy (open group). The two groups were compared regarding demographic information, physical examination, radiological evaluations, and perioperative indicators. The clinical outcomes were assessed in accordance with the Oswestry Disability Index (ODI), visual analog scale (VAS), and modified MacNab criteria. Results:The postoperative ODI and VAS scores were significantly improved in both groups compared with the preoperative baseline values (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (P < 0.001), and the satisfactory rate was 90.5% in both groups in accordance with the modified MacNab criteria. There were no significant differences between the two groups in the clinical outcomes and complication rate (. Conclusions:PETD has a similar outcome to the conventional surgical method for the treatment of upper LDH but provides the typical advantages of minimally invasive procedures such as reduced iatrogenic injury, minimal activity restrictions, and accelerated ambulation recovery postoperatively.

Project description:This study aimed to evaluate and compare the clinical effectiveness of two surgical techniques-unilateral biportal endoscopic (UBE) discectomy and percutaneous interlaminar endoscopic lumbar discectomy (IELD)-in addressing high-grade down-migrated lumbar disc herniation (HDM-LDH). A retrospective analysis was conducted on 39 patients with HDM-LDH who underwent surgical treatment between January 2020 and February 2023. This cohort included 18 patients in the UBE group and 21 patients in the IELD group. The two endoscopic techniques were compared based on operative time, intraoperative blood loss, hemoglobin decrease, C-reactive protein levels, and length of hospital stay. Efficacy was evaluated using the visual analog scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. The IELD group exhibited a shorter operative duration and reduced length of hospital stay, as well as diminished intraoperative blood loss compared to the UBE group (P < 0.05). No statistically significant differences were observed in the reduction of hemoglobin levels or the increase in C-reactive protein between the two groups (P > 0.05). Postoperatively, both groups experienced significant decreases in VAS scores and ODI scores relative to preoperative values. One day post-surgery, the VAS score for low back pain was higher in the UBE group than in the IELD group, with the difference being statistically significant (P < 0.05). However, no significant differences were found in the VAS scores for lower limb pain at any time point, nor in the ODI scores one day, one month, and three months post-surgery (P > 0.05). At the final follow-up, patient satisfaction rates were 94.44% in the UBE group and 95.24% in the IELD group, with no statistically significant difference (P > 0.05). One patient in the IELD group developed neurological symptoms following surgery. Both UBE and IELD demonstrate significant clinical efficacy in the treatment of HDM-LDH. The IELD technique is characterized by its minimally invasive nature, whereas UBE offers greater flexibility and a notably enhanced decompression effect. Clinicians are advised to select the appropriate technique based on individual patient conditions and specific clinical scenarios.

Project description:Study designThis was a survey of the surgeon members of the Lumbar Spine Research Society (LSRS).ObjectiveThe purpose of this study was to assess trends in surgical practice and patient management involving elective and emergency surgery in the early months of the coronavirus pandemic.Summary of background dataThe novel coronavirus has radically disrupted medical care in the first half of 2020. Little data exists regarding the exact nature of its effect on spine care.MethodsA 53-question survey was sent to the surgeon members of the LSRS. Respondents were contacted via email 3 times over a 2-week period in late April. Questions concentrated on surgical and clinical practice patterns before and after the pandemic. Other data included elective surgical schedules and volumes, as well as which emergency cases were being performed. Surgeons were asked about the status of coronavirus disease 2019 (COVID-19) virus testing. Circumstances for performing surgical intervention on patients with and without testing as well as patients testing positive were explored.ResultsA total of 43 completed surveys were returned of 174 sent to active surgeons in the LSRS (25%). Elective lumbar spine procedures decreased by 90% in the first 2 months of the pandemic, but emergency procedures did not change. Patients with "stable" lumbar disease had surgeries deferred indefinitely, even beyond 8 weeks if necessary. In-person outpatient visits became increasingly rare events, as telemedicine consultations accounted for 67% of all outpatient spine appointments. In total, 91% surgeons were under some type of confinement. Only 11% of surgeons tested for the coronavirus on all surgical patients.ConclusionsElective lumbar surgery was significantly decreased in the first few months of the coronavirus pandemic, and much of outpatient spine surgery was practiced via telemedicine. Despite these constraints, spine surgeons performed emergency surgery when indicated, even when the COVID-19 status of patients was unknown.Level of evidenceLevel IV.

Dataset Information

Survey research of patient's preference on choosing microscopic or endoscopic spine surgery for lumbar discectomy.

Background

Methods

Results

Conclusions

Publications

Survey research of patient's preference on choosing microscopic or endoscopic spine surgery for lumbar discectomy.

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