Percutaneous endoscopic interlaminar discectomy of L5–S1 disc herniation: a comparison between intermittent endoscopy technique and full endoscopy technique

Abstract

BackgroundPercutaneous endoscopic laminar discectomy is a typical minimally invasive discectomy operation that is classified into the percutaneous endoscopic transforaminal discectomy and the percutaneous endoscopic interlaminar discectomy. Based on whether the surgeon chooses to deal with the ligamentum flavum under endoscope guidance, percutaneous endoscopic discectomy by the interlaminar approach can be performed with a full endoscope technique with the intermittent endoscope technique. To our knowledge, there is no study comparing these two techniques in regard to their surgical effects and advantages. Therefore, we conducted this study to compare the cost, safety, and efficacy between the intermittent endoscopy technique and full endoscopy technique of endoscopic interlaminar lumbar discectomy at the L5–S1 level.MethodsFrom September 2014 to March 2015, a total of 126 patients with radiculopathy due to L5–S1 disc herniation who were treated by a full endoscopy technique (65 patients) or intermittent endoscopy technique (61 patients) were included. Relevant data, such as duration time of the operation, hospitalization expenses, postoperative bed rest time, length of hospitalization, and complication rates, were recorded. Clinical outcomes were assessed by the visual analog scale score, modified MacNab criteria, and Oswestry disability index.ResultsIn the full endoscope (FE) group, the mean duration time of surgery was 75.0 ± 11.9 min. The postoperative bed rest time was 6.5 ± 1.1 h, length of hospitalization was 3.8 ± 1.1 days, and complication rate was 7.69%. In the intermittent endoscopy (IE) group, the mean duration time of surgery was 43.0 ± 16.4 min. The postoperative bed rest time was 5.0 ± 1.1 h, length of hospitalization was 3.6 ± 1.2 days, and complication rate was 6.60%. The average hospitalization expenses of the FE group and IE group, respectively, were 32,069 ± 1086 RMB and 22,665 ± 899 RMB. There were significant differences in the surgical duration and hospitalization expenses (P < 0.01), but no differences between the two groups in postoperative bed rest time, length of hospitalization, or complication rates (P > 0.05). The postoperative Oswestry disability index and VAS were clearly improved in both groups compared with those of preoperation (P < 0.01). These two procedures have the same clinical outcomes (P > 0.05).ConclusionsBoth the full endoscopy technique and intermittent endoscopy technique achieved good outcomes, whereas the intermittent endoscopy technique is a more effective option for a shorter duration surgery and lower hospitalization expenses.

A comparison between remaining and resecting the posterior longitudinal ligament in percutaneous endoscopic transforaminal discectomy for disc herniation: A retrospective cohort study

“…For decades, minimally invasive spine surgery has been increasingly popular in treating LDH for multiple advantages compared with the open technique: such as less invasive, decreased blood loss, faster function recovery, shorter length of hospitalization, and lower risk of spinal instability [9][10][11].PETD via inside-and-out approach has become one of the most common minimally invasive spinal surgeries since Yeung et al developed the spinal endoscopic YESS system in 2002 [7,12].Many studies have indicated that this technique could achieve good results with effective nerve root decompression, low complication rates for most types of LDH [13][14][15][16]. Yeung et al [7] reported 307 cases of LDH treated with the this technique followed-up for more than one year, and the excellent -to -good rate was 89.3%.…”

Endoscopic Interlaminar Discectomy Using Simple Technique Without the use of Complicated Industrial Tubular Systems

“…This percutaneous technique depends on directly targeting the disc fragment with very minimal work on ligaments or bone. Although this technique is associated with minimal tissue damage but still not suitable for large migrated fragments and associated with higher recurrence rate, also it is difficult with this technique to achieve sufficient decompression in cases of lumber stenosis [8] .…”

“…Generally speaking endoscopic spine surgery has the advantages of less tissue dissection, reduced blood loss, minimal epidural fibrosis, less hospital stay, early functional recovery, improvement in quality of life, better cosmoses and less cost of treatment [8] .…”

“…Our technique involved certain steps that differ from other methods of endoscopic spine surgery. Positioning the patient lateral with 30 degrees tilt away from the surgeon instead of prone position that has been used by most endoscopic spine surgeons [1,8,12,13] . We found that, this position make it more easy in handling the surgical instruments with 30 to 45 degrees to the horizontal plane.…”

“…Different techniques have been described in the literature for the fully endoscopic lumbar discectomy. All of them used tubular systems manufactured by spine companies; each system has its limitation of work and sophisticated way of use in addition to the obligation to use their endoscopic system [6][7][8][9] . In this study we described our modified surgical technique in of endoscopic interlaminar discectomy using simple port custom made from 20cc syringe and using our ordinary sinoscope without the use of complicated industrial tubular systems.…”