Is Full Endoscopic Lumbar Discectomy Less Invasive Than Conventional Surgery? A Randomized MRI Study

Tacconi, Leonello; Signorelli, Francesco; Giordan, Enrico

doi:10.1016/j.wneu.2020.03.123

Cited by 19 publications

(27 citation statements)

References 16 publications

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“…The outcomes are comparable to those observed with traditional techniques regarding postoperative pain, operative time, time to mobilization, and time to discharge. Also, endoscopic techniques have the advantage of almost negligible muscle damage, disc destruction, and blood loss [1][2][3].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis

et al. 2021

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Introduction: Spinal endoscopic techniques have recently been applied to complex degenerative conditions or failed back surgery syndrome. We performed a systematic review and meta-analysis to assess transforaminal endoscopic lumbar foraminotomy (TELF) outcomes and adverse event rates. We also analyzed the effectiveness of the technique for chronic pain after arthrodesis or previous spinal surgery. Methods: Multiple databases were searched for studies published in the English language, involving patients [ 18 years old who underwent endoscopic foraminotomy. Outcomes included the rate of patients who showed ''excellent'' and ''good'' postoperative improvement, decreased leg pain, and improved Oswestry Disability Index (ODI) scores. Adverse events considered in the analysis included nerve root damage and intraoperative dural tear, the proportion of patients requiring revision surgery or recurrences, and infections. Results: A total of 14 studies, encompassing 600 patients, were identified. Approximately 85% of patients improved significantly after TELF, without significant differences among different groups (85% vs. 78%, respectively). Mean leg pain decreased an average of 5.2 points, and ODI scores improved by 41.2%. Patients with previous spine surgery or failed back surgery syndrome had higher postoperative leg dysesthesia rates after TELF (14% vs. 1%, respectively). Conclusion: TELF is a useful and safe method to achieve decompression in foraminal stenosis. This technique is indicated in the elderly or patients with comorbidities. Preoperative planning is paramount in determining the foraminal size and endoscope trajectory. A diamond burr is recommended because it has an advantage over the regular endoscopic shaver in bleeding control and complication avoidance.

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Section: Introductionmentioning

confidence: 99%

Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis

et al. 2021

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“…PTED can offer many advantages compared to traditional open surgery, and it has been increasingly used for the treatment of LDH [ 4 , 5 , 21 , 22 ]. In clinical practice, transforaminal needle placement was perceived to be the most critical and challenging step of this operation.…”

Section: Discussionmentioning

confidence: 99%

“…It is widely accepted as a safe and effective technique [ 1 – 3 ]. It can limit soft tissue retraction and dissection, which results in decreased postoperative pain and improved functional recovery [ 4 , 5 ]. With the advancement of MISS, percutaneous transforaminal endoscopic discectomy (PTED) has become an alternative approach for treating lumbar disc herniation (LDH) [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

A real-time 3D electromagnetic navigation system for percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation: a retrospective study

Wei

Yao

et al. 2022

BMC Musculoskelet Disord

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Background In this study, we present a novel electromagnetic navigation (EMN) system for percutaneous transforaminal endoscopic discectomy (PTED) procedure. The objective of this study was to investigate the safety and effectiveness of the PTED with the assistance of the EMN system and compare it with the conventional PTED with the assistance of fluoroscopic guidance (C-arm). Methods The clinical data of 79 patients (32 in EMN group and 47 in C-arm group) undergoing PTED for lumbar disc herniation (LDH) from January to September of 2019 were analyzed retrospectively. The radiation time, puncture time, operation time, visual analog scale (VAS), Oswestry disability index (ODI), modified MacNab criteria, and radiological parameters were recorded in both groups. Results Radiation time, puncture time, and operation time were significantly reduced in the EMN group compared with the C-arm group (P < 0.05). Compared with the C-arm group, a steeper learning curve was observed in the EMN group. There were no significant differences between the two groups regarding VAS and ODI scores at different time points (P > 0.05). The satisfaction rates of the EMN and C-arm groups were 90.63 and 87.23%, respectively, but no significant difference was found between the two groups (P > 0.05). There was no significant difference regarding translation and angular motion between the two groups at preoperation and postoperation (P > 0.05). Conclusions The EMN system can be applied to facilitate the PETD procedure. It can significantly reduce the intraoperative radiation time, puncture time, and operation time, and reshape the learning curve of PTED. Due to limitations of a retrospective study, results may need validation with larger prospective randomized clinical trials.

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“…Twenty trials performed the comparison between ED and NED. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Five trials performed the comparison between PETD and PEID. [35][36][37][38][39] Among those trials comparing ED with NED, PELD was performed in 10 trials, 16,20,[22][23][24][25][26]31,33,34 FE in 4 trials 21,[28][29][30] and MED in 6 trials.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

“…[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Five trials performed the comparison between PETD and PEID. [35][36][37][38][39] Among those trials comparing ED with NED, PELD was performed in 10 trials, 16,20,[22][23][24][25][26]31,33,34 FE in 4 trials 21,[28][29][30] and MED in 6 trials. 15,[17][18][19]27,32 The characteristics of the included trials were shown in Table 1 and Table 2.…”

Section: Study Selection and Characteristicsmentioning

confidence: 99%

Comparison of Endoscopic Discectomy Versus Non-Endoscopic Discectomy for Symptomatic Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

Yan

Lin

2021

Global Spine Journal

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Study Design: Systematic review. Objective: The authors aimed to systematically compare the effectiveness and safety of endoscopic discectomy (ED) with non-endoscopic discectomy (NED) for treatment of symptomatic lumbar disc herniation (LDH). Methods: A systematic search was performed on PubMed, EMBASE, the Cochrane Library and China National Knowledge Infrastructure for randomized controlled trial from inception until August 13, 2020. Trials which investigated multiple operative approaches on lumbar disc herniation were identified without language restrictions. Results: In total, 25 trials involving 2258 patients with symptomatic LDH were included. Twenty trials performed the comparison between ED and NED. Five trials performed the comparison between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). The operative time of micro-endoscopic discectomy (MED) was longer than open discectomy (OD). The length of hospital stay of percutaneous endoscopic lumbar discectomy (PELD) was shorter than fenestration discectomy (FD). Significant differences in intraoperative blood loss volumes were found between PELD with FD and MED with OD. The complication rate of PELD was lower than FD (PELD: 4.3%; FD: 14.6%) and the complication rate of full-endoscopic discectomy (FE) was lower than microscopic discectomy (MD) (FE: 13.4%; MD: 32.1%). Conclusions: PELD and FE have the advantage of limiting intraoperative damages. ED and NED can be both considered sufficient to achieve good clinical outcomes. PETD and PEID are able to achieve similar results but the learning curve of PETD was steeper. More independent high-quality RCTs with sufficiently large sample sizes performing cost-effectiveness analyzes are needed.

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Is Full Endoscopic Lumbar Discectomy Less Invasive Than Conventional Surgery? A Randomized MRI Study

Cited by 19 publications

References 16 publications

Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis

Endoscopic Transforaminal Lumbar Foraminotomy: A Systematic Review and Meta-Analysis

A real-time 3D electromagnetic navigation system for percutaneous transforaminal endoscopic discectomy in patients with lumbar disc herniation: a retrospective study

Comparison of Endoscopic Discectomy Versus Non-Endoscopic Discectomy for Symptomatic Lumbar Disc Herniation: A Systematic Review and Meta-Analysis

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