Comparison of the invasiveness of conventional discectomy and microendoscopic discectomy for lumbar disc herniation: Differences in the methods of approach

Hara, Manabu; Takahashi, Hiroshi; Yokoyama, Yuichirou; Wada, Akihito; Hasegawa, Katsuhiko; Iida, Yusuke

doi:10.1111/ases.12143

Cited by 6 publications

(5 citation statements)

References 11 publications

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“…Epidural hematoma is another common complication, one of the possible reasons for this is that the high intraoperative water pressure obscures the bleeding point, causing intraoperative visual field loss, and therefore, the intraoperative lavage hydraulic pressure should be optimally controlled at 25–30 mmHg [ 38 ]. In conclusion, UBE treatment for LSS can effectively improve the efficiency and shorten the operation time, and has the advantages of less trauma, less bleeding and significant improvement of postoperative pain symptoms, and a much lower incidence of lumbar instability [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the results of open PLIF versus UBE PLIF in lumbar spinal stenosis: postoperative adjacent segment instability is lesser in UBE

Liu

2023

J Orthop Surg Res

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Objective To compare the difference in efficacy between open PLIF and UBE for lumbar spinal stenosis and the effect on postoperative adjacent segment instability. Method The clinical data of 37 patients with PLIF and 32 patients with UBE for lumbar spinal stenosis were retrospectively analyzed to compare the differences in perioperative conditions and short- and medium-term outcomes. Results All 69 patients completed the surgery successfully. The operating time, number of intraoperative fluoroscopies and hospital days were higher in the UBE group than in the open PLIF group. Intraoperative bleeding and postoperative drainage were lower than in the open PLIF group (P < 0.05). The visual analogue scale (VAS) of low back pain was lower in the UBE group than in the open PLIF group at 1 month and 3 months postoperatively (P < 0.05), and there were no statistically significant VAS scores for low back pain in the two groups at 1 day and 6 months postoperatively (P > 0.05). Leg pain VAS scores were lower in the UBE group than in the open PLIF group at 1 month, 3 months and 6 months postoperatively (P < 0.05), and leg pain VAS scores were not statistically significant in both groups at 1 day postoperatively (P > 0.05). The ODI index was lower in the UBE group than in the open PLIF group at 1 day and 1 month postoperatively (P < 0.05) and was not statistically significant in the two groups at 3 months and 6 months postoperatively (P > 0.05). There was no statistically significant difference between the two groups in postoperative interbody height, sagittal diameter of the spinal canal, efficacy of modified MacNab and interbody fusion (P > 0.05). The open PLIF group was more prone to postoperative adjacent vertebral instability than the UBE group, and the difference was statistically significant (P < 0.05). Conclusion With appropriate indications, the open PLIF group and the UBE group had similar short- and medium-term clinical outcomes for the treatment of lumbar spinal stenosis, but patients in the UBE group had better symptomatic improvement than the open PLIF group at 3 months postoperatively, and the effect on postoperative adjacent vertebral instability was smaller in the endoscopic group than in the open PLIF group.

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Section: Discussionmentioning

confidence: 99%

Comparison of the results of open PLIF versus UBE PLIF in lumbar spinal stenosis: postoperative adjacent segment instability is lesser in UBE

Liu

2023

J Orthop Surg Res

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“…But, these open surgical dissections denervated all core group of paraspinal muscles which remains the main reason for postoperative back pain and muscle atrophy at the operated segment [26]. In contrast to the conventional open surgeries of spine, endoscopic surgery inflicts minimum muscle damage [27]. Most importantly, decreasing the multifidus muscle damage is an important factor in keeping the spinal segment stability [28].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Radiologic Outcomes of Biportal Endoscopic Lumbar Interbody Fusion With a Long Polyetheretherketone Cage

Park¹,

Anzar²,

Yoo³

et al. 2023

J Minim Invasive Spine Surg Tech

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Objective: With the latest advances and innovations in field of spine surgery, the new generation of spine surgeons has been increasingly preferring the endoscopic lumbar interbody fusion technique to treat the pathology of lumbar degenerative disease. The aim of this study was to elucidate the clinical and radiologic outcomes of biportal endoscopic lumbar interbody fusion with a long polyetheretherketone (PEEK) cage.Methods: This study included 40 patients treated by biportal endoscopic lumbar interbody fusion with a long PEEK cage between January 2020 and December 2021. The clinical evaluation was conducted using improvements in visual analogue scale (VAS) and Oswestry Disability Index (ODI) scores. Radiological outcomes were evaluated by changes in disc height and segmental and lumbar lordosis. Fusion was assessed based on computed tomography scans using the Bridewell criteria. Surgical parameters (e.g., operative duration, blood loss and complications) were noted.Results: Of the 40 patients in this study, 13 were male and 27 were female. Most patients had significant clinical improvement as indicated by improvements in VAS and ODI scores (p < 0.05). Disc height, segmental lordosis, and lumbar lordosis showed significant improvements (p < 0.05). The mean surgical duration was 180 minutes, and the mean blood loss was 80 mL. All patients had grade 1 or 2 fusion.Conclusion: Biportal endoscopic fusion using a long PEEK cage is an excellent option for achieving good interbody fusion when indicated. A long-term follow-up study would be needed to fully clarify the effectiveness of this procedure.

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“…1,2,17,29,30 These results were comparable with conventional procedures. [7][8][9] Endoscopic techniques can be as effective as an open technique for lumbar canal decompression with the additional benefits of decreased complications and morbidity. 31 It was found to be effective in patients with a far lateral disk, 32 in obese patients, 33 in those with a recurrent disk, 34,35 in patients with or without degenerative spondylolisthesis, 36 and in those with a large uncontained disk.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 Minimal muscle dissection, better visualization, removal of contralateral compressive pathologies, reduced morbidity, short hospital stay, and ultimately a lower cost of treatment are some of the advantages of the endoscopic technique over the conventional open technique. 3,4 Although there are many reports about safety, favorable outcome, 5 how much facet removal is safe for spinal stability, 6 comparison with open surgery [7][8][9] or with microsurgery, 10 advantages of the endoscopic technique, 11,12 and the learning curve [13][14][15] after endoscopic decompression in the lumbar spine, to the best of our knowledge, only two studies have reported the extent of decompression after endoscopic surgery. 16,17 Postoperative mean spinal canal area and sagittal diameter of the lateral recess were found to be significantly larger after surgery compared with preoperative dimensions in the Zhou et al series.…”

Section: Introductionmentioning

confidence: 99%

Extent of Decompression of Lumbar Spinal Canal after Endoscopic Surgery

Dewanngan

Yadav

Parihar

et al. 2017

J Neurol Surg A Cent Eur Neurosurg

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Endoscopic techniques are being used in lumbar disk disease and lumbar canal stenosis to decompress the spinal canal. The present study analyzed pre- and postoperative magnetic resonance imaging (MRI) measurements of the lumbar canal. This was a prospective study of 30 lumbar levels. Patients< 18 years of age with unilateral compression, previous surgery at the same level, and spinal instability were excluded. Endoscopic posterior decompression was used. Pre- and postoperative MRIs of all the patients were performed. Anteroposterior (AP), transverse, interfacet diameter, canal surface area, and height and angle of the lateral recess were measured. Mean ages of male and female patients were 42.1 ± 10.3 and 45.0 ± 9.9 years, respectively. Pathologies were at L4-L5, L5-S1, and L2-L3 levels in 16, 13, and 1 patient, respectively. There was significant improvement in AP diameter (4.75 ± 1.75 mm to 10.33 ± 2.11 mm), interfacet distance (12.70 ± 4.86 mm to 18.92 ± 3.53 mm), and canal surface area (76.45 ± 25.36 mm to 187.13 ± 41.04 mm) after decompression. Significant improvement was noted in mean height and angle of lateral recess after surgery of both sides suggesting that effective decompression of the bilateral canal was possible using a unilateral approach. Most of the patients (90%) showed excellent and good improvement after surgery. Postoperative canal surface area and AP diameter in patients who did not have any pain after surgery or had pain requiring occasional medication was higher compared with patients who continued to complain of pain and required continuous pain medication. Although the number of patients was small with a short follow-up, the endoscopic technique was effective in improving AP diameter, interfacet distance, canal surface area, lateral recess height, and lateral recess angle, suggesting that an endoscopic technique using a unilateral approach is effective in bilateral decompression of neural elements.

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Comparison of the invasiveness of conventional discectomy and microendoscopic discectomy for lumbar disc herniation: Differences in the methods of approach

Abstract: MED was found to be less invasive than conventional discectomy based on ethological, blood biochemical, and histological examinations.

Cited by 6 publications

References 11 publications

Comparison of the results of open PLIF versus UBE PLIF in lumbar spinal stenosis: postoperative adjacent segment instability is lesser in UBE

Comparison of the results of open PLIF versus UBE PLIF in lumbar spinal stenosis: postoperative adjacent segment instability is lesser in UBE

Clinical and Radiologic Outcomes of Biportal Endoscopic Lumbar Interbody Fusion With a Long Polyetheretherketone Cage

Extent of Decompression of Lumbar Spinal Canal after Endoscopic Surgery

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