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Transforaminal Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation With High Iliac Crest: Technical Note and Preliminary Series.

ABSTRACT: With the trend of minimally invasive spine surgery, full-endoscopic lumbar discectomy (FELD) has evolved with the advancement of the optics and instruments. Regarding the techniques, the transforaminal and interlaminar approach remain the major accesses in FELD. Transforaminal endoscopic lumbar discectomy (TELD) is an effective and safe treatment for herniation of the lumbar disc. More and more evidence supports the TELD in enhancing recovery and decreasing surgical complications. However, the learning curve of TELD remains steep, especially at the L5-S1 level. The iliac crest height is an essential factor in the operability of TELD at the L5-S1 level. In the situation of the high iliac crest, TELD is technically challenging even for an experienced surgeon. Therefore, the authors report their techniques of TELD with foraminoplasty step-by-step and the preliminary results in this report.

SUBMITTER: Chen KT

PROVIDER: S-EPMC7410374 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Transforaminal Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation With High Iliac Crest: Technical Note and Preliminary Series.

Chen Kuo-Tai KT Wei Sung-Tai ST Tseng Chun C Ou Su-Wei SW Sun Li-Wei LW Chen Chien-Min CM

Neurospine 20200731 Suppl 1

With the trend of minimally invasive spine surgery, full-endoscopic lumbar discectomy (FELD) has evolved with the advancement of the optics and instruments. Regarding the techniques, the transforaminal and interlaminar approach remain the major accesses in FELD. Transforaminal endoscopic lumbar discectomy (TELD) is an effective and safe treatment for herniation of the lumbar disc. More and more evidence supports the TELD in enhancing recovery and decreasing surgical complications. However, the l ...[more]

PMID: 32746521

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Project description:This was a retrospective study. The present study investigates whether Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach(PELD) is no less effective than posterior lumbar interbody fusion(PLIF) in the treatment of L4/5 and L5/S1 two-level disc herniation. In this retrospective study, we included 40 patients with L4/5 and L5/S1 two-level lumbar disc herniation (LDH) who received PELD (n = 18) or PLIF (n = 22). The two groups are divided into a united group(PELD) and a fusion group(PLIF). In the united group, the transforaminal approach was adopted for L4/5 level disc herniation, and the interlaminar approach was adopted for L5/S1 level disc herniation. The degree of nerve root and dural compression determined by MRI was taken preoperatively. The clinical outcomes which preoperative 1 week, 3 months,6 months,12 months, 24 months, 36months and final follow-up after surgery between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), the Japanese Orthopaedic Association (JOA) and the modified MacNab criteria. In both groups, the VAS, ODI and JOA scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05). According to the modified MacNab criteria, the excellent or good outcome rate was 94.44% in the united group and 90.91% in the fusion group. Within 1 week after the operation, there was a significant difference in the improvement of clinical symptoms between the combination group and the fusion group (P < 0.05), and the combination group was better than the fusion group. Additionally, within three months postoperatively, the combination group exhibited significantly better functional improvements compared to the fusion group .With the gradual recovery of patients, there was no significant difference in the improvement of clinical symptoms between the two groups (P > 0.05). To sum up, This study aimed to compare the efficacy of PELD and PLIF in the treatment of dual-segmental lumbar disc herniation of L4/5 and L5/S1. Compared with PLIF, PELD has advantages in less intraoperative bleeding, shorter operation time and non-general anesthesia. However, the possibility of postoperative recurrence of PLIF is lower. In short, both methods can bring satisfactory results to patients. Clinically, surgeons should carefully weigh the advantages and disadvantages of the two operations and choose the operation method suitable for patients. At the same time, in future studies, we should further extend the follow-up time to observe whether vertebral fusion has more advantages in preventing postoperative recurrence.

Project description:BackgroundOne of the main difficulties in a transforaminal endoscopic lumbar discectomy (TELD), and simultaneously the most critical step, is performing an effective and safe foraminoplasty, which is especially difficult for beginners. To make it safer and faster for beginners to perform, we have used a specially designed power-aided reciprocating burr for TELD and reported the technical details.MethodsFrom Jan. 2019 to Nov. 2022, 432 patients with single-level, symptomatic L4/5 or L5/S1 disc herniation were treated with TELD using a novel power-aided reciprocating burr. The surgical procedure is described in detail. Magnetic resonance imaging (MRI) was performed the following day and 3 months after the operation. The learning curves of surgeons with different seniority levels are displayed. The Visual Analogue Scale (VAS) score and the Oswestry Disability Index (ODI) were used to measure low back pain, leg pain, and lumbar function. All patients were followed up for at least 1 year.ResultsAll patients underwent endoscopic surgery successfully. Among the 432 patients, radicular outer membrane damage was observed in 6 cases, and 1 case had hernia of the nerve tract. Except for this patient with aggravation of postoperative numbness, the postoperative neurological symptoms of all patients were significantly improved. The mean VAS scores for low back pain and leg pain and ODI scores were significantly decreased 6 w post-operatively and were maintained until 12 months post-operatively compared to preoperative scores (P < 0.05). All three doctors involved in the study had substantial experience in traditional open spinal surgery. The more operations all three surgeons completed, the more time spent on intervertebral foraminoplasty decreased (P < 0.05). Among them, doctors without experience in TELD surgery became proficient in this technique after accumulating experience in 13 cases. There was no significant difference in foraminoplasty time among these three surgeons during the same growing period (P > 0.05).ConclusionsCurrent clinical data demonstrated the safety and efficacy of modified TELD using a power-aided reciprocating burr for treating lumbar disc herniation (LDH) and showed that this technique significantly reduces the learning curve for beginners when performing foraminoplasty.

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.

Dataset Information

Transforaminal Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation With High Iliac Crest: Technical Note and Preliminary Series.

Publications

Transforaminal Endoscopic Lumbar Discectomy for L5-S1 Disc Herniation With High Iliac Crest: Technical Note and Preliminary Series.

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