Clinical evaluation of percutaneous transforaminal endoscopic discectomy (PTED) and paraspinal minitubular microdiscectomy (PMTM) for lumbar disc herniation: study protocol for a randomised controlled trial

Abstract

IntroductionFor sciatica caused by lumbar disc herniation (LDH), the standard surgical technique is conventional microdiscectomy. In recent years, minimally invasive techniques (eg, percutaneous transforaminal endoscopic discectomy (PTED), paraspinal minitubular microdiscectomy (PMTM)) have gained increasing interest. PTED and PMTM are considered alternative minimally invasive techniques for the treatment of LDH. Due to insufficient evidence, the differences in efficacy between PTED and PMTM have been debated. A pragmatic, multicentre, non-inferiority, randomised controlled trial has been designed to determine the efficacy and cost-effectiveness of PTED versus PMTM for the treatment of LDH.Methods and analysisA total of 280 patients (18–70 years) presenting with significant symptoms of sciatica and failure after 3 months of conservative treatment will be recruited. Patients must have an indication for surgery based on MRI demonstrating LDH with nerve root compression. Patients will be randomised to PTED or PMTM treatment. The primary outcome is Oswestry Disability Index scores. Secondary outcomes include Visual Analogue Scale scores, Short Form 36 health survey scores, physical examination, length of hospital stay, costs and complications. Outcomes will be measured the day following surgery, at 1 week, and at 1, 3, 6, 12 and 24 months after surgical treatment. Physical examination will be conducted at 1 week, 1 month and 12 months after surgery. The non-inferiority margin for the primary outcome is 5.Ethics and disseminationEthical approval has been granted by the Ethics Committee of Fujian Medical University Union Hospital, Fuzhou, China (2018YF010-02). Results of the research will be published in an international peer-reviewed scientific journal and disseminated through presentation at scientific conferences.Trial registration numberChiCTR1800015727; Pre-results.

A comparative study of conventional microlumbar discectomy and endoscopic lumbar discectomies

“…A study conducted by Liang et al patient population, the study was divided into below and above the age of 40 years similar to our study, and it was observed that the patients above 40 years were more commonly affected similarly to the findings in our study. 4 This signifies that this is a degenerative process whose incidence increases with age similar to findings of Goda et al 5 Various authors observed increased incidence in the young male population (<40 years) due to lack of physical activity and sedentary lifestyle. 6 A comparative study between interlaminar and microlumbar discectomy by Markovic et al of 570 patients showed that the commonest level affected was L4/5 followed by L5/S1 and L3/4 in that order as per our findings.…”

Prognosis Evaluation of MRI Combined with Magnetic Resonance Myelography on Lumbar Disc Herniation after Transforaminal Endoscopic Discectomy

“…T 1 weighted image (T1WI) parameters are as follows: TR 700 ms, TE 10 ms, layer thickness 4.5 mm, layer spacing 0.9 mm, and acquisition times 2; T2WI parameters are as follows: TR 3700 ms, TE 120 ms, layer thickness 4.5 mm, layer spacing 0.9 mm, and acquisition times 2. An axial scan of the L4-S1 intervertebral discs was performed with the T2WI parameters as follows: TR 4500 ms, TE 120 ms, layer thickness 5.0 mm, layer spacing 0.9 mm, and acquisition times 3 [16,17]; (2) MRM examination: the anterior and posterior edges of the dural sac on the coronal plane were scanned using three-dimensional (3D) fast asymmetric spin-echo (FASE) sequences with the scanning parameters of TR 8000 ms, TE 120 ms, layer thickness 1 mm, and acquisition times 1. Fat suppression technology was used to reduce the systemic tissue signal and highlight the CSF signal, thus clearly outlining the spinal cord structure.…”

Percutaneous transforaminal endoscopic discectomy ameliorates postoperative reactive pain in patients with lumbar disc herniation

“…As a result, the in ammatory mediators of the nucleus pulposus are released and gather around the nerve roots. Different from the open discectomy, PTED is performed under the water boundary during the operation [9,19,20], which may effectively prevent the aggregation of local in ammatory substances thorough continuous irrigation. Furthermore, previous studies demonstrated that in ammatory substances may also be released by the locally damaged tissue around the surgical site [21,22], that may also stimulate the nerve roots and cause reactive pain.…”