Posterior endoscopic discectomy: Results in 300 patients

Kaushal, Mohinder; Sen, Ramesh Kumar

doi:10.4103/0019-5413.91640

Cited by 35 publications

(35 citation statements)

References 24 publications

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“…Surgical technique was not always specified, but larger series of patients treated through interlaminar approach were growing through the years. Specifically, both Yadav and Kaushal reported 400 and 300 patients treated through interlaminar approach, respectively [ 40 , 51 ]. However, this should not be misleading.…”

Section: Resultsmentioning

confidence: 99%

Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence

Anichini

Landi

Caporlingua

et al. 2015

BioMed Research International

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Endoscopic disc surgery (EDS) for lumbar spine disc herniation is a well-known but developing field, which is increasingly spreading in the last few years. Rate of recurrence/residual, complications, and outcomes, in comparison with standard microdiscectomy (MD), is still debated and need further data. We performed an extensive review based on the last 6 years of surgical series, systematic reviews, and meta-analyses reported in international, English-written literature. Articles regarding patients treated through endoscopic transforaminal or interlaminar approaches for microdiscectomy (MD) were included in the present review. Papers focused on endoscopic surgery for other spinal diseases were not included. From July 2009 to July 2015, we identified 51 surgical series, 5 systematic reviews, and one meta-analysis reported. In lumbar EDS, rate of complications, length of hospital staying, return to daily activities, and overall patients' satisfaction seem comparable to standard MD. Rate of recurrence/residual seems higher in EDS, although data are nonhomogeneous among different series. Surgical indication and experience of the performing surgeon are crucial factors affecting the outcome. There is growing but still weak evidence that lumbar EDS is a valid and safe alternative to standard open microdiscectomy. Statistically reliable data obtained from randomized controlled trials (better if multicentric) are desirable to further confirm these results.

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Section: Resultsmentioning

confidence: 99%

Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence

Anichini

Landi

Caporlingua

et al. 2015

BioMed Research International

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“…2,3,9,[17][18][19]21,25,26,28,33,36,[41][42][43]45,49,[52][53][54][56][57][58]61 MED techniques employ a longitudinal paramedian incision through which a tubular retractor is placed and visualization is achieved through an endoscope. 2,6,10,13,19,24,25,29,36,46,51,53,57,60,62,64 Percutaneous discectomy entails placing a sheath directly into the disc space via a transforaminal approach, extraforaminal approach, or interlaminar approach and then using a suction/debrider or chemical injection to remove the disc. 1,11,12,23,30,37,44,50 To assess the risk of bias for each study, 3 reviewers (M.F.S., J.J.X., and E.Y.T.)…”

Section: Data Collectionmentioning

confidence: 99%

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

Shriver¹,

Xie

Tye³

et al. 2015

FOC

127

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OBJECT Lumbar microdiscectomy and its various minimally invasive surgical techniques are seeing increasing popularity, but a systematic review of their associated complications has yet to be performed. The authors sought to identify all prospective clinical studies reporting complications associated with lumbar open microdiscectomy, microendoscopic discectomy (MED), and percutaneous microdiscectomy. METHODS The authors conducted MEDLINE, Scopus, Web of Science, and Embase database searches for randomized controlled trials and prospective cohort studies reporting complications associated with open, microendoscopic, or percutaneous lumbar microdiscectomy. Studies with fewer than 10 patients and published before 1990 were excluded. Overall and interstudy median complication rates were calculated for each surgical technique. The authors also performed a meta-analysis of the reported complications to assess statistical significance across the various surgical techniques. RESULTS Of 9504 articles retrieved from the databases, 42 met inclusion criteria. Most studies screened were retrospective case series, limiting the number of studies that could be included. A total of 9 complication types were identified in the included studies, and these were analyzed across each of the surgical techniques. The rates of any complication across the included studies were 12.5%, 13.3%, and 10.8% for open, MED, and percutaneous microdiscectomy, respectively. New or worsening neurological deficit arose in 1.3%, 3.0%, and 1.6% of patients, while direct nerve root injury occurred at rates of 2.6%, 0.9%, and 1.1%, respectively. Hematoma was reported at rates of 0.5%, 1.2%, and 0.6%, respectively. Wound complications (infection, dehiscence, orseroma) occurred at rates of 2.1%, 1.2%, and 0.5%, respectively. The rates of recurrent disc complications were 4.4%, 3.1%, and 3.9%, while reoperation was indicated in 7.1%, 3.7%, and 10.2% of operations, respectively. Meta-analysis calculations revealed a statistically significant higher rate of intraoperative nerve root injury following percutaneous procedures relative to MED. No other significant differences were found. CONCLUSIONS This review highlights complication rates among various microdiscectomy techniques, which likely reflect real-world practice and conceptualization of complications among physicians. This investigation sets the framework for further discussions regarding microdiscectomy options and their associated complications during the informed consent process.

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“…Kaushal and Sen in 2012 evaluated the results of 300 posterior lumbar MIS endoscopic discectomies performed for managing disc disease [ Table 1 ]. [ 19 ] The results were evaluated utilizing MacNab's criteria after a minimum follow-up of 12 months and maximum follow-up of 24 months. Outcomes were excellent/good in 90% of patients, fair in 8%, and poor in 2%.…”

Section: Lumbar Nerve Root Injuries With Minimally Invasive Surgerymentioning

confidence: 99%

More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

Epstein

2016

Surg Neurol Int

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Background:In the lumbar spine, do more nerve root injuries occur utilizing minimally invasive surgery (MIS) techniques versus open lumbar procedures? To answer this question, we compared the frequency of nerve root injuries for multiple open versus MIS operations including diskectomy, laminectomy with/without fusion addressing degenerative disc disease, stenosis, and/or degenerative spondylolisthesis.Methods:Several of Desai et al. large Spine Patient Outcomes Research Trial studies showed the frequency for nerve root injury following an open diskectomy ranged from 0.13% to 0.25%, for open laminectomy/stenosis with/without fusion it was 0%, and for open laminectomy/stenosis/degenerative spondylolisthesis with/without fusion it was 2%.Results:Alternatively, one study compared the incidence of root injuries utilizing MIS transforaminal lumbar interbody fusion (TLIF) versus posterior lumbar interbody fusion (PLIF) techniques; 7.8% of PLIF versus 2% of TLIF patients sustained root injuries. Furthermore, even higher frequencies of radiculitis and nerve root injuries occurred during anterior lumbar interbody fusions (ALIFs) versus extreme lateral interbody fusions (XLIFs). These high frequencies were far from acceptable; 15.8% following ALIF experienced postoperative radiculitis, while 23.8% undergoing XLIF sustained root/plexus deficits.Conclusions:This review indicates that MIS (TLIF/PLIF/ALIF/XLIF) lumbar surgery resulted in a higher incidence of root injuries, radiculitis, or plexopathy versus open lumbar surgical techniques. Furthermore, even a cursory look at the XLIF data demonstrated the greater danger posed to neural tissue by this newest addition to the MIS lumbar surgical armamentariu. The latter should prompt us as spine surgeons to question why the XLIF procedure is still being offered to our patients?

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Posterior endoscopic discectomy: Results in 300 patients

Cited by 35 publications

References 24 publications

Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence

Lumbar Endoscopic Microdiscectomy: Where Are We Now? An Updated Literature Review Focused on Clinical Outcome, Complications, and Rate of Recurrence

Lumbar microdiscectomy complication rates: a systematic review and meta-analysis

More nerve root injuries occur with minimally invasive lumbar surgery, especially extreme lateral interbody fusion: A review

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