Clinical Outcomes After Microendoscopic Discectomy for Recurrent Lumbar Disc Herniation

Smith, Justin S.; Ogden, Alfred T.; Shafizadeh, Stephen; Fessler, Richard G.

doi:10.1097/bsd.0b013e318193c16c

Cited by 65 publications

(45 citation statements)

References 22 publications

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“…33 The overall success rate of 90% in our series is comparable to reported success rates of MED and ETD in the literature. 1,7,14,15,24,25,32,39,43 The mean operative time of 90 ± 35 minutes is comparable to other series using MED (98-102 minutes). 15,24,25 The instability/fusion rate in our series was 6.7%.…”

Section: Discussionsupporting

confidence: 67%

“…15,24,25 The instability/fusion rate in our series was 6.7%. In another series of 16 patients 43 and in two 10-patient series described by Le et al 24 and Isaacs et al 15 in 2003, no case of instability and fusion was reported. In our series, we report an incidental durotomy rate of 16.7%.…”

Section: Discussionmentioning

confidence: 99%

“…10,17,34,42,43 Microendoscopic discectomy (MED) uses a tubular transmuscular working channel (16-20 mm) to approach the spine coupled with an endoscope to enable visualization. 8,9,31,33,35,44,51,52,54,55 The same muscle-splitting device can also be used with the microscope to perform a minimally invasive microdiscectomy.…”

mentioning

confidence: 99%

“…[2][3][4][11][12][13][20][21][22]26,49 Also, full endoscopic techniques have been used for the treatment of LDH via an interlaminar or transforaminal (endoscopic transforaminal discectomy [ETD]) approach. 16,[28][29][30][36][37][38][39][40][41]53 Over the last decade, MED and ETD have been applied to treat recurrent LDH 1,7,14,15,24,25,32,39,43 (Table 1). The outcomes were reported to be equal and sometimes favorable compared with open microdiscectomy for recurrent LDH.…”

mentioning

confidence: 99%

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Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Hubbe¹,

Franco-Jimenez²,

Klingler³

et al. 2016

SPI

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OBJECT The aim of the study was to investigate the safety and efficacy of minimally invasive tubular microdiscectomy for the treatment of recurrent lumbar disc herniation (LDH). As opposed to endoscopic techniques, namely microendoscopic and endoscopic transforaminal discectomy, this microscopically assisted technique has never been used for the treatment of recurrent LDH. METHODS Thirty consecutive patients who underwent minimally invasive tubular microdiscectomy for recurrent LDH were included in the study. The preoperative and postoperative visual analog scale (VAS) scores for pain, the clinical outcome according to modified Macnab criteria, and complications were analyzed retrospectively. The minimum follow-up was 1.5 years. Student t-test with paired samples was used for the statistical comparison of pre- and postoperative VAS scores. A p value < 0.05 was considered to be statistically significant. RESULTS The mean operating time was 90 ± 35 minutes. The VAS score for leg pain was significantly reduced from 5.9 ± 2.1 preoperatively to 1.7 ± 1.3 postoperatively (p < 0.001). The overall success rate (excellent or good outcome according to Macnab criteria) was 90%. Incidental durotomy occurred in 5 patients (16.7%) without neurological consequences, CSF fistula, or negative influence to the clinical outcome. Instability occurred in 2 patients (6.7%). CONCLUSIONS The clinical outcome of minimally invasive tubular microdiscectomy is comparable to the reported success rates of other minimally invasive techniques. The dural tear rate is not associated to higher morbidity or worse outcome. The technique is an equally effective and safe treatment option for recurrent LDH.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Hubbe¹,

Franco-Jimenez²,

Klingler³

et al. 2016

SPI

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“…28 In cases of revision surgery, it is important to remove additional bone superior to the previous laminotomy to access normal dura, and then follow that plane into the scarred area.…”

Section: Discussionmentioning

confidence: 99%

Tubular microdiscectomy: techniques, complication avoidance, and review of the literature

Clark

Safaee

Khan

et al. 2017

Neurosurgical Focus

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OBJECTIVEMicroendoscopic discectomy is a minimally invasive surgery technique that was initially described in 1997. It allows surgeons to work with 2 hands through a small-diameter, operating table–mounted tubular retractor, and to apply standard microsurgical techniques in which a small skin incision and minimal muscle dissection are used. Whether the surgeon chooses to use an endoscope or a microscope for visualization, the technique uses the same type of retractor and is thus called tubular microdiscectomy. The goal in this study was to review the current literature, examine the level of evidence supporting tubular microdiscectomy, and describe surgical techniques for complication avoidance.METHODSThe authors performed a systematic PubMed review using the terms “microdiscectomy trial,” “tubular and open microdiscectomy,” “microendoscopic open discectomy,” and “minimally invasive open microdiscectomy OR microdiskectomy.” Of 317 references, 10 manuscripts were included for analysis based on study design, relevance, and appropriate comparison of open to tubular discectomy.RESULTSSimilar and very favorable clinical outcomes can be expected from tubular and standard microdiscectomy. Studies have demonstrated equivalent operating times for both procedures, with lower blood loss and shorter hospital stays associated with tubular microdiscectomy. Furthermore, postoperative analgesic usage has been shown to be significantly lower after tubular microdiscectomy. Overall rates of complications are no different for tubular and standard microdiscectomy.CONCLUSIONSProspective randomized trials have been used to evaluate outcomes of common minimally invasive lumbar spine procedures. For lumbar discectomy, Level I evidence supports equivalently good outcomes for tubular microdiscectomy compared with standard microdiscectomy. Likewise, Level I data indicate similar safety profiles and may indicate lower blood loss for tubular microdiscectomy. Future studies should examine the comparative value of these procedures.

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The function of CD146 in human annulus fibrosus cells and mechanism of the regulation by TGF‐β

Guo

Häckel

et al. 2021

Journal Orthopaedic Research

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The mouse outer annulus fibrosus (AF) was previously shown to contain CD146+ AF cells, while in vitro culture and exposure to transforming growth factor‐beta (TGF‐β) further increased the expression of CD146. However, neither the specific function of CD146 nor the underlying mechanism of TGF‐β upregulation of CD146+AF cells have been elucidated yet. In the current study, CD146 expression and its role in cultured human AF cells was investigated studying the cells’ capacity for matrix contraction and gene expression of functional AF markers. In addition, TGF‐β pathways were blocked by several pathway inhibitors and short hairpin RNAs (shRNAs) targeting SMAD and non‐SMAD pathways to investigate their involvement in TGF‐β‐induced CD146 upregulation. Results showed that knockdown of CD146 led to reduction in AF cell‐mediated collagen gel contraction, downregulation of versican and smooth muscle protein 22α (SM22α), and upregulation of scleraxis. TGF‐β‐induced CD146 upregulation was significantly blocked by inhibition of TGF‐β receptor ALK5, and partially inhibited by shRNA against SMAD2 and SMAD4 and by an Protein Kinase B (AKT) inhibitor. Interestingly, the inhibition of extracellular signal‐regulated kinases (ERK) pathway induced CD146 upregulation. In conclusion, CD146 was shown to be crucial to maintain the cell contractility of human AF cells in vitro. Furthermore, TGF‐β upregulated CD146 via ALK5 signaling cascade, partially through SMAD2, SMAD4, and AKT pathway, whereas, ERK was shown to be a potential negative modulator. Our findings suggest that CD146 can potentially be used as a functional marker in AF repair strategies.

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Clinical Outcomes After Microendoscopic Discectomy for Recurrent Lumbar Disc Herniation

Cited by 65 publications

References 22 publications

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Tubular microdiscectomy: techniques, complication avoidance, and review of the literature

The function of CD146 in human annulus fibrosus cells and mechanism of the regulation by TGF‐β

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