Extreme cases in percutaneous transforaminal endoscopic surgery: case series and brief review of the literature

Kapetanakis, Stylianos; Floros, Evangelos; Gkantsinikoudis, Nikolaos

doi:10.1080/02688697.2021.1944981

Cited by 6 publications

(7 citation statements)

References 11 publications

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“…In contrast, PES is used in the treatment of ASD after lumbar fusion because of its advantages of less trauma, faster recovery, and fewer complications. Moreover, its effectiveness and safety have been demonstrated in previous clinical studies [ 15 , 20 – 42 ]. Nonetheless, studies on PES for ASD remain scarce, and no systematic review to prove its effectiveness exists.…”

Section: Discussionmentioning

confidence: 94%

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Safety and clinical efficacy of endoscopic procedures for the treatment of adjacent segmental disease after lumbar fusion: A systematic review and meta-analysis

et al. 2023

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Background Adjacent segment disease (ASD) is a common complication after lumbar fusion and is still traditionally treated by open surgery. In recent years, with the development of minimally invasive techniques, percutaneous endoscopic surgery(PES) has been used for the treatment of ASD after lumbar fusion due to its unique benefits. Nevertheless, it remains unclear about its significant clinical efficacy and advantages over conventional open surgery. Objectives To evaluate the clinical efficacy and safety of PES in the treatment of ASD after lumbar fusion. Study design A systematic review and meta-analysis studies about the role of PES in managing ASD after lumbar fusion. Methods A systematic search review was conducted in PubMed, EMBASE, Cochrane Library, Web of Science, CNKI, VIP, WanFang, and SinoMed databases from the start of their construction to 15 November 2021. Eligible studies included references to clinical trials of PES for ASD after open lumbar fusion. Observations included pain relief, recovery of postoperative function, overall excellent rates, and indicators of the advantages of minimally invasive surgery compared to conventional surgery. Postoperative complications and recurrence rates were also recorded. Results A total of 24 studies, including 20 single-arm studies and 4 clinical control studies, all involving 928 patients were included. A total of 694 patients were included in the single-arm analysis. The results of the single-arm meta-analysis showed that PES could significantly reduce low back and leg pain and improve the functional status of the lumbar spine in patients with ASD after open lumbar fusion compared to preoperatively, and had good clinical efficacy after surgery. A total of 234 patients were included in the four clinically controlled studies, and the results of the meta-analysis showed that PES could clearly reduce pain and improve lumbar function, with no significant difference in efficacy between PES and open surgery. However, PES has a lower surgical incision, less intraoperative bleeding, and shorter operative time and length of hospital stay compared to open surgery. Moreover, it has a lower rate of postoperative recurrence as well as complications and a longer duration of efficacy. Conclusions On the basis of the available clinical literature and the results of this study, PES could achieve satisfactory clinical effects in ASD treatment after lumbar fusion. Compared with conventional open surgery, PES can not only obtain similar clinical results, but also had the advantages of less trauma and faster recovery. Nevertheless, a randomized controlled study is still needed to validate the findings of this study. Trial registration Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42022298387.

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Section: Discussionmentioning

confidence: 94%

“…Eight databases were searched according to the search strategy described in the Methods section, and 1954 studies were retrieved after de-duplication. Finally, a total of 24 clinical studies [ 15 , 20 – 42 ] qualified for the meta-analysis. The specific screening process and results are shown in Fig 1 .…”

Section: Resultsmentioning

confidence: 99%

Safety and clinical efficacy of endoscopic procedures for the treatment of adjacent segmental disease after lumbar fusion: A systematic review and meta-analysis

et al. 2023

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“…The titles and abstracts of the remaining 561 references were screened, and 506 were excluded because they did not meet the inclusion criteria. The remaining 55 articles underwent full-text screening, of which a further 28 articles were excluded because 17 ( 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 ) were on patients with foraminal stenosis and an excluded indication, 4 ( 26 , 27 , 28 , 29 ) were on open decompression, 3 ( 30 , 31 , 32 ) reported no outcomes of interest, 2 ( 33 , 34 ) were letters to editors or surgical technique notes, 1 ( 35 ) was on foraminal stenosis secondary to fusion surgery, and 1 ( 36 ) was on a combination of 2 or more procedures. A further four articles were excluded because one ( 37 ) was on a subset of a larger cohort ( 38 ), and three ( 39 , 40 , 41 ) presented the outcomes of interest graphically or as net changes but did not present specific postoperative values (the authors were contacted at least three times but none responded).…”

Section: Resultsmentioning

confidence: 99%

Section: Literature Searchmentioning

confidence: 99%

SPINE: High heterogeneity and no significant differences in clinical outcomes of endoscopic foraminotomy vs fusion for lumbar foraminal stenosis: a meta-analysis

et al. 2023

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Objective This study aimed to systematically review the literature for comparative and non-comparative studies reporting on clinical outcomes of patients with lumbar foraminal stenosis treated by either endoscopic foraminotomy or fusion. Methods In adherence with Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines, a literature search was done on January 17, 2022, using Medline and Embase. Clinical studies were eligible if they reported outcomes following fusion or endoscopic foraminotomy, in patients with primary lumbar foraminal stenosis. Two independent reviewers screened titles, abstracts, and full-texts to determine eligibility; performed data extraction; and assessed the quality of eligible studies according to the Joanna Briggs Institute (JBI) checklist. Results The search returned 827 records; 266 were duplicates, 538 were excluded after title/abstract/full-text screening, and 23 were eligible, with 16 case series reporting on endoscopic foraminotomy, 7 case series reporting on fusion, and no comparative studies. The JBI checklist indicated that 21 studies scored ≥4 points. When comparing endoscopic foraminotomy to fusion, pooled data revealed reduced operative time (69 vs 119 min, P < 0.01) but similar Oswestry disability index (19 vs 20, P = 0.67), lower back pain (2 vs 2, P = 0.11), leg pain (2 vs 2, P = 0.15), complication rates (10% vs 5%, P = 0.22), and reoperation rates (5% vs 0%, P = 0.16). The proportions of patients with good/excellent MacNab criteria were similar for endoscopic foraminotomy and fusion (82–91% vs 85–91%). Conclusions There were high heterogeneity and no significant differences in clinical outcomes, complication rates, and reoperation rates between endoscopic foraminotomy and fusion for the treatment of lumbar foraminal stenosis; although endoscopic foraminotomy has reduced operative time.

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“…Stylianos Kapetanakis et al have reported that TLED has been used satisfactorily in some extreme cases, such as foraminal stenosis (FS) in adult degenerative scoliosis (ADS), recurrent foraminal stenosis (RFS) after previous open decompression surgery, and adjacent segment disease (ASD) after previous lumbar fusion. 20 However, the use of TLED as a revision surgery can be challenging for beginners because it involves factors such as the alteration of normal physiological anatomy by scar tissue after previous surgery. 20 Moreover, the learning curve of TLED is very steep, and mastering it requires the operator to have high fine operation skills and three-dimensional thinking, while endoscopic operation requires the operator to master the anatomical structure skillfully.…”

Section: Discussionmentioning

confidence: 99%

Effect of Collagenase Chemonucleolysis on Residual Pain After Transforaminal Lumbar Endoscopic Discectomy

Han¹,

Li²,

Chen³

et al. 2023

JPR

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Purpose To investigate the short-term clinical effect of collagenase chemonucleolysis (CCNL) in the treatment of residual pain after transforaminal lumbar endoscopic discectomy (TLED). Patients and Methods The clinical data of 40 patients with residual pain after TLED for lumbar disc herniation (LDH) in our hospital from January 2018 to December 2020 were retrospectively analyzed. The visual analogue scale (VAS) and quality of recovery-15 (QoR-15) were used to evaluate the effect of the operation. Modified MacNab method was used to evaluate the efficacy of CCNL at 6 months and 12 months after operation. Results All patients successfully completed the operation without serious complications, such as intervertebral space infection, vascular injury and nerve injury. The VAS 3 days after TLED was not significantly lower than that Pre-TLED (P > 0.05). The VAS at each time point after CCNL was significantly lower than that at Pre-TLED, and the QoR-15 score at each time point after CCNL was significantly higher than that 3 days after CCNL (P < 0.05). The modified MacNab criteria for the last follow-up was 95%. Conclusion CCNL can effectively relieve the residual pain after TLED, and the quality of life of patients after TLED is improved with time, and the safety of CCNL is higher.

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Extreme cases in percutaneous transforaminal endoscopic surgery: case series and brief review of the literature

Cited by 6 publications

References 11 publications

Safety and clinical efficacy of endoscopic procedures for the treatment of adjacent segmental disease after lumbar fusion: A systematic review and meta-analysis

Safety and clinical efficacy of endoscopic procedures for the treatment of adjacent segmental disease after lumbar fusion: A systematic review and meta-analysis

SPINE: High heterogeneity and no significant differences in clinical outcomes of endoscopic foraminotomy vs fusion for lumbar foraminal stenosis: a meta-analysis

Effect of Collagenase Chemonucleolysis on Residual Pain After Transforaminal Lumbar Endoscopic Discectomy

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