Comparison of Clinical Outcomes of Two-Level PELD and Foraminoplasty PELD for Highly Migrated Disc Herniations: A Comparative Study

Abstract

Objective The aim of this study is to compare the clinical outcomes of two-level percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty PELD in treating highly migrated lumbar disc herniations. Methods Patients with highly migrated lumbar disc herniations were enrolled from May 2014 to June 2016. Low back pain and leg pain were evaluated by the Visual Analog Scale (VAS), and functional outcomes were assessed with the Oswestry Disability Index (ODI). The satisfaction rate of clinical outcomes was assessed according to the modified MacNab criteria. In addition, the intraoperative duration and postoperative complications were also recorded. Results Forty patients, 14 cases in two-level PELD group and 26 cases in foraminoplasty PELD group, were included. The VAS scores of low back pain (P=0.67) and leg pain (P=0.86), as well as the ODI scores (P=0.87), were comparative between two-level PELD and foraminoplasty PELD groups. The satisfaction rate of clinical outcomes based on the modified MacNab criteria in the two-level PELD group was equivalent to that in foraminoplasty PELD group (92.9% versus 92.3%, P=0.92). In addition, the intraoperative duration of two-level PELD group was longer than that of foraminoplasty PELD group (80.2 ± 6.6 min versus 64.1 ± 7.3 min, P < 0.01). The postoperative complications in the two-level PELD group (postoperative dysesthesia: N = 1) were relatively fewer as compared to those in the foraminoplasty PELD group (postoperative dysesthesia: N = 1; recurrence: N = 1; nucleus pulposus residues: N = 1). Conclusions Both two-level PELD and foraminoplasty PELD are safe and effective surgical procedures for the patients with highly migrated lumbar disc herniations. Moreover, the two-level PELD technique has merits in reducing the incidence of postoperative nucleus pulposus residue.

Endoscopic and Microscopic Interlaminar Discectomy for the Treatment of Far-Migrated Lumbar Disc Herniation: A Retrospective Study with a 24-Month Follow-Up

“… 29 , 31 , 33 It should be noted that the target location, limited possibility of endoscopic adjustment, and risks of dural tears and incomplete removal of the herniated disc may limit the application of these methods. 29 , 31 , 33 Two-level PELD techniques such as the transforaminal approach alone or in combination with an interlaminar approach reduce the incidence of postoperative nucleus pulposus residue, 30 , 32 but these procedures are cumbersome, have a long operative time, and cannot be used for L5–S1 far-migrated LDH. 29 , 32 The results of our study show that sciatica in both the IELD and IMLD groups significantly improved and remained satisfactory at the 24-month follow-up, indicating that adequate decompression was achieved, which is in accordance with other published reports.…”

“…Although the incidence of complications was higher with the latter, no major complications occurred. Modified PELD techniques have been used to treat farmigrated LDH, with good clinical results; 20,22,[29][30][31][32][33] However, these methods have various shortcomings and limitations. Several studies have reported good clinical results in more than 90% of patients with far-migrated DH treated by PETLD, but it is difficult to directly view the distal free nucleus pulposus due to obstruction of the facet joint and pedicle, especially as the far-migrated disc is often separated into many fragments.…”

Transforaminal endoscopic lumbar discectomy with targeted puncture and foraminotomy for very highly migrated disc herniation: A technique note with case series

“…Wu et al. reported 26 cases of VHMDH using the foraminoplasty endoscopic technique and obtained a 92.3% satisfactory rate [ 27 ]. In addition to the establishment of a widened foraminal working window, the choice of puncture point and direction also ultimately determines whether TELD treatment will be successful.…”

Transcriptome Analysis of Pseudomonas aeruginosa Biofilm Following the Exposure to Malaysian Stingless Bee Honey

“…Wu et al, 2019 reported pelD as an exopolysaccharide transporter. 51 This could explain the trial of the cell to abrogate the transformation from the biofilm form by up-regulation of the exopolysaccharide synthesis.…”

“…Moreover, PeLG has shown to have a catalytic activity as a degrader of ePsl in the extracellular matrix, so consistently, it will cause an exopolysaccharide degradation. 51 Byrd et al, 2009 showed overlapping of the enzymatic roles in the biosynthesis of Psl, LPS production, and the part of Psl genes in surface conditioning and attachment. These results aroused an amending trial of Pseudomonas to transform into a planktonic state to render the inhibitory effect of honey.…”