Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Hubbe, Ulrich; Franco-Jimenez, Pamela; Klingler, Jan-Helge; Vasilikos, Ioannis; Scholz, Christoph; Kogias, Evangelos

doi:10.3171/2015.4.spine14883

Cited by 30 publications

(16 citation statements)

References 53 publications

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“…Currently, PTED and MED are the most widely performed minimally invasive procedures in treating single-level LDH. MED is carried out based on traditional open surgery and microdiscectomy, and the surgical field is effectively enlarged with the use of a micro-endoscope, which minimizes damage to surrounding tissues [6,8]. PTED combines the endoscope and radiofrequency techniques and achieves direct extraction of the protruding disc by a working channel, which has the advantages of minimal invasiveness, less bleeding, easier anesthesia, and faster postoperative recovery [9,32].…”

Section: Discussionmentioning

confidence: 99%

“…MED, first described by Foley et al in 1997 [7], uses a micro-endoscope for visualization and the paraspinous muscles are handled by muscle splitting through dilators, which causes less trauma to the muscle and soft tissue. Numerous studies have confirmed its safety and efficacy, even when treating recurrent LDH [6,8]. PTED, introduced by Yeung et al in 2002 [9], is more minimally invasive, with posterior column lumbar structures preserved.…”

Section: Introductionmentioning

confidence: 99%

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Percutaneous Transforaminal Endoscopic Discectomy versus Micro-Endoscopic Discectomy for Lumbar Disc Herniation

et al. 2019

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Background Percutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are alternative minimally invasive, widely performed procedures for the treatment of lumbar disc herniation (LDH). This study compared the clinical outcomes of these 2 surgical techniques in treating LDH. Material/Methods A comprehensive literature search was performed in PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar to identify all relevant studies comparing PTED and MED in treating LDH. Results Eight comparative studies assessing a total of 805 patients were included for the final analysis. The results indicated that PTED needs a shorter incision [−1.02 (−1.21 to −0.83), p<0.001], less time in bed [−2.14 (−3.34 to −0.94), p<0.001], and shorter hospital stay [−1.92 (−2.90 to −0.94), p<0.001], whereas MED is superior regarding intraoperative fluoroscopy [7.47 (2.78 to 12.17), p=0.002] and total cost [0.69 (0.38 to 1.00), p<0.001]. No significant differences were found on operation time, intraoperative blood loss, or complications. Significant lower back pain was found in the PTED group at 1 week postoperatively [−0.52 (−0.95 to −0.10), p=0.02] and 1 year postoperatively or the last follow-up [−0.41 (−0.76 to −0.06), p=0.02]; significant lower leg pain was also detected at 1 week postoperatively [−0.52 (−0.75 to −0.30), p<0.001]. Oswestry Disability Index (ODI) was significant better at 1 week postoperatively in the PTED group [−4.41 (−7.03 to −1.79), p=0.001]. No significant differences were detected at other time points regarding pain score and ODI. Conclusions Both PTED and MED are safe and effective techniques for treating LDH. However, taking all clinical outcomes together, PTED might be a preferable treatment modality for LDH.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Percutaneous Transforaminal Endoscopic Discectomy versus Micro-Endoscopic Discectomy for Lumbar Disc Herniation

et al. 2019

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“…Muscle injury can also be minimized by the use of minimally invasive muscle-sparing techniques [ 25 ], and selected minimally invasive procedures have also proven to be cost-effective in recently published cost-utility analysis [ 26 , 27 ]. Although the use of minimally invasive techniques has grown over the past few years, now becoming part of the surgeons' armamentarium for the treatment of numerous spinal conditions [ 28 – 33 ], the number of technical reports and publications focusing on the surgical challenges associated with minimally invasive muscle-sparing treatment of isthmic spondylolysis with symptomatic spondylolisthesis in adults is still limited [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

Roberti

Arsenault

2020

Minimally Invasive Surgery

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“…While more technically demanding than traditional open discectomy, the use of tubular discectomy spread more widely after the adaptation of the instrumentation and technique to direct visualization utilizing an operative microscope. While clinical outcomes have been shown to be equivalent between open and tubular techniques, there are concerns regarding reherniation rates, as minimal removal of nuclear material is thought by some authors to contribute to post-discectomy reherniation and, ultimately, reoperation [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Implantation of a bone-anchored annular closure device in conjunction with tubular minimally invasive discectomy for lumbar disc herniation: a retrospective study

Martens¹,

Lesage²,

Muir³

et al. 2018

BMC Musculoskelet Disord

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BackgroundMinimally invasive techniques for lumbar discectomy have been recommended as superior to open techniques due to lower blood loss, lower rates of infection and shorter recovery. There are, however, concerns that this approach does not sufficiently remove the herniated nuclear material, thus leaving the patient susceptible to reherniation requiring reoperation. The purpose of this study was to examine the safety and viability of an annular closure device in limiting reherniation and reoperation in a cohort of patients undergoing minimally invasive lumbar discectomy with the assistance of an annular closure device.MethodsWe retrospectively analysed the results from patients treated by a single surgeon between March 2011 and December 2017. All patients had been diagnosed with a large (≥ 5 mm) defect and were treated via minimally invasive surgical techniques. Outcomes included demographic data, the procedural duration and the rates of symptomatic reherniation and reoperation.Results60 patients were included in the study. The mean age was 42 years (range: 19–66); mean BMI was 24.1 (range: 16.7–36.3). Mean surgical duration was 29 min (range: 16–50). Reoperation was required in 5% (3/60) of patients, although only 3% (2/60) experienced symptomatic reherniation at the index level. No other complications were reported.ConclusionsIn our study, the use of an annular closure device during minimally invasive lumbar discectomy in a population of patients with large herniations was associated with low rates of reherniation and reoperation at the index level. While more research is required, the results of this study demonstrate the safety and viability of the annular closure device as an adjunct to minimally invasive discectomy.

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Minimally invasive tubular microdiscectomy for recurrent lumbar disc herniation

Cited by 30 publications

References 53 publications

Percutaneous Transforaminal Endoscopic Discectomy versus Micro-Endoscopic Discectomy for Lumbar Disc Herniation

Percutaneous Transforaminal Endoscopic Discectomy versus Micro-Endoscopic Discectomy for Lumbar Disc Herniation

Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

Implantation of a bone-anchored annular closure device in conjunction with tubular minimally invasive discectomy for lumbar disc herniation: a retrospective study

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