Fully Endoscopic Interlaminar and Transforaminal Lumbar Discectomy: Short-Term Clinical Results of 163 Surgically Treated Patients

Sencer, Altay; Yörükoğlu, Ali Güven; Akçakaya, Mehmet; Aras, Yavuz; Aydöseli, Aydın; Boyalı, Osman; Şencan, Fahir; Sabancı, Pulat Akın; Gömleksiz, Cengiz; İmer, Murat; Kırış, Talat; Hepgül, Kemal; Ünal, Ömer Faruk; İzgi, Nail; Canbolat, Ali

doi:10.1016/j.wneu.2014.05.032

Cited by 74 publications

(62 citation statements)

References 43 publications

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“…Other studies report similar recurrence rates. 4,25,29 Another research group published the short-term clinical results of 163 patients who underwent either PTED or full-endoscopic interlaminar discectomy. 25 They reported a recurrent LDH rate of 2.8% in the PTED group, which is lower than our rate.…”

Section: Discussionmentioning

confidence: 99%

“…4,25,29 Another research group published the short-term clinical results of 163 patients who underwent either PTED or full-endoscopic interlaminar discectomy. 25 They reported a recurrent LDH rate of 2.8% in the PTED group, which is lower than our rate. An important reason for this difference could be that the patients in their study were selected to undergo either PTED or interlaminar endoscopic surgery on the basis of CT imaging.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, our rate of complications was very low and comparable to the rates reported in the literature. 10,25,26,29 Nellensteijn et al 18 were the first to provide a systematic review of the PTED technique. Their review identified only 1 randomized controlled trial with a low risk of bias.…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Gadjradj

Tulder²,

Dirven

et al. 2016

FOC

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OBJECTIVE Throughout the last decades, full-endoscopic techniques to treat lumbar disc herniation (LDH) have gained popularity in clinical practice. To date, however, no Class I evidence on the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) has been published, and studies describing its safety and short- and long-term efficacy are scarce. In this study the authors aimed to evaluate the clinical outcomes and safety in patients undergoing PTED for LDH. METHODS Patients who underwent PTED for LDH between January 2009 and December 2012 were prospectively followed. The primary outcomes were the visual analog scale (VAS) score for leg pain and the score on the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes were the perceived experience with the local anesthesia used and satisfaction with the results after 1 year using Likert-type scales. The pretreatment means were compared with the means obtained 6 and 52 weeks after surgery using paired t-tests. RESULTS A total of 166 patients underwent surgery for a total of 167 LDHs. The mean duration of surgery (± SD) was 51.0 ± 9.0 minutes. The 1-year follow-up rate was 95.2%. The mean reported scores on the VAS and QBPDS were 82.5 ± 17.3 mm and 60.0 ± 18.4 at baseline, respectively. Six weeks after surgery, the scores on the VAS and QBPDS were significantly reduced to 28.8 ± 24.5 mm and 26.7 ± 20.6, respectively (p < 0.001). After 52 weeks of follow-up, the scores were further reduced compared with baseline scores (p < 0.001) to 19.6 ± 23.5 mm on the VAS and 20.2 ± 18.1 on the QBPDS. A total of 4 complications were observed, namely 1 dural tear, 1 deficit of ankle dorsiflexion, and 2 cases of transient paresis in the foot due to the use of local anesthetics. CONCLUSIONS PTED appears to be a safe and effective intervention for LDH and has similar clinical outcomes compared to conventional open microdiscectomy. High-quality randomized controlled trials are required to study the efficacy and cost-effectiveness of PTED.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Gadjradj

Tulder²,

Dirven

et al. 2016

FOC

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“…Most of the clinical series using this technique show low morbidity; which is usually related to dural tears. 17,23,24,31,38,39,46 In our series we had four patients of dural tears (2.6%); two of them (1.3%) developed CSF leaks; and one (0.6%) developed pseudomeningocele. We had one patient (0.6%) of partial nerve root injury (L5 root) that responded to pregabalin.…”

Section: A B C Dmentioning

confidence: 85%

“…Our results were comparable to others. 17,19,23,38,39,46 In Choi et al, 7 series the mean preoperative VAS was 7.89 (Ranged from 6-10). At the last follow-up examination, after an average period of 18 months postoperatively, the mean VAS was 1.58 (Range 0-7), this improvement was statistically significant (P<0.001).…”

Section: Foley and Smithmentioning

confidence: 96%

Three-year Follow-Up Results of Lumbar Microendoscopic Discectomy (MED): A Prospective Study in 150 Patients

Elwany

Farhoud

Zidan

et al. 2017

Egyptian Spine Journal

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Background Data: The goal of all described surgical techniques to treat lumbar disc prolapse is removing the offending disc material, decompressing the nerve root, and relieving neurologic symptoms while avoiding complications. The goal of minimum invasiveness is to minimize the added morbidity of a larger exposure; including the creation of perineural scarring. Microendoscopic discectomy (MED) is a minimally invasive technique to treat lumbar disc prolapse. It is unique in that it combines open surgical principles with endoscopic technology. Follow-up will show whether MED will improve upon the long-term results of the "gold standard" procedures. Purpose: To evaluate the efficacy of lumbar MED, regarding results, safety, complications, stability of effectiveness, incidence of recurrence, instability and redo surgeries after 3 years of follow up. Study Design: A prospective clinical case study Patients and Methods: We report 150 patients with lumbar disc prolapse, admitted at the Neurosurgery Department; Alexandria Main University Hospital and operated with MED technique. Patients were followed for 3 years. Clinical and radiological data were collected preoperatively and postoperativly. The degree of pain and disability were assessed using VAS and ODI. The length of the incision, the duration of surgery, and the average operative blood loss were calculated. Patients were followed at 2 weeks, 3 months, 1 year and 3 years. Results: This study included 150 patients; with 162 levels operated. 138 patients (92 %) had single level and 12 patients (8%) had double level surgery. L4-5 was the most common level. The mean duration of surgery was 55.0 minutes. The mean blood loss was 40.0 cc. The mean duration of hospital stay was 1.3 day. 81.3% of patients returned to their work in less than four weeks. The average length of skin incision was 2.38 cm. Intraoperative complications included four dural tears (2.6%), one (0.6%) pseudomeningocele, one (0.6%) partial nerve root injury (L5 root), and 3 (2%) superficial wound infection. No patient had postoperative instability or recurrences in the follow up period. There was a statistically significant difference between preoperative and postoperative VAS and ODI in the follow up evaluations (at 2 weeks, 3 months, 1 year & 3 years) (P=<0.001). Conclusion: MED technique allowed nerve root decompression; with minimal complications and preserving normal anatomy, with faster recoveries. For surgeons accustomed to performing endoscopic surgery, the use of MED is a safe and reliable alternative to microscopic discectomy. (2017ESJ124)

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Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta‐analysis of cohort studies

Machado

Witzleb

Fritsch

et al. 2016

European Journal of Pain

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Although surgery is followed by a rapid decrease in pain and disability by 3 months, patients still experience mild to moderate pain and disability 5 years after surgery. WHAT DOES THIS REVIEW ADD?: This review provides a quantitative summary of the postoperative course of patients with sciatica. Patients with sciatica experienced a rapid reduction in pain and disability in the first 3 months, but still had mild to moderate symptoms 5 years after surgery. Although no significant differences were found, microdiscectomy showed larger improvements compared to other surgical techniques.

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Fully Endoscopic Interlaminar and Transforaminal Lumbar Discectomy: Short-Term Clinical Results of 163 Surgically Treated Patients

Cited by 74 publications

References 43 publications

Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Clinical outcomes after percutaneous transforaminal endoscopic discectomy for lumbar disc herniation: a prospective case series

Three-year Follow-Up Results of Lumbar Microendoscopic Discectomy (MED): A Prospective Study in 150 Patients

Patients with sciatica still experience pain and disability 5 years after surgery: A systematic review with meta‐analysis of cohort studies

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