Quality of conscious sedation using dexmedetomidine during full-endoscopic transforaminal discectomy for sciatica: a prospective case series

Gadjradj, Pravesh S.; Sharma, Jamie R J Arjun; Harhangi, Biswadjiet S.

doi:10.1007/s00701-021-05100-x

Cited by 7 publications

(7 citation statements)

References 24 publications

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“…8 Local anesthesia was administered. 13 An incision was made just above the dorsolateral side of the pelvis, where a needle was set from the incision to the superior articular process of the lower involved vertebrae of the herniated disc. After the needle had reached the superior articular process, a guidewire was inserted.…”

Section: ) Ptedmentioning

confidence: 99%

Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica

et al. 2022

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Objective: Full-endoscopic spine surgery is gaining interest as a less-invasive alternative to treat sciatica caused by a lumbar disc herniation. Concerns, however, exist with the learning curve as percutaneous transforaminal endoscopic discectomy (PTED) appears to be more difficult to be performed compared to other techniques. In this study, the clinical outcomes during and after the learning curve are presented of 3 surgeons naïve to PTED.Methods: In the first phase of a randomized controlled, noninferiority trial comparing PTED with microdiscectomy, 3 surgeons were trained in the PTED-procedure by a senior surgeon. After performing up to 20 cases under supervision, they started performing PTED on their own. Results of the early cases were compared to the later cases (>20). Furthermore, complications and reoperations were compared. Finally, differences in clinical outcomes between surgeons were compared.Results: At 12 months of follow-up, 87% of the patients had follow-up data available. In general, there were no significant differences in patient-reported outcomes between the early and later PTED cases. Furthermore, outcomes of the early PTED cases were comparable to the outcomes of microdiscectomy, while the later PTED cases had small, but more favorable outcomes compared to microdiscectomy. Two learning curve surgeons had substantially higher rates of reoperations within 1 year, compared to the senior surgeon or the microdiscectomy group. Duration of surgery was also longer for all learning curve surgeons. Finally, when comparing clinical outcomes of patients undergoing PTED versus microdiscectomy, there appears to be some statistically significant differences in outcomes compared between the senior and 3 learning curve surgeons.Conclusion: PTED appears to be safe to be adopted by surgeons naïve to the procedure when they are initially supervised by an experienced senior surgeon. Duration of surgery and risk of repeated surgery are increased during the learning curve, but patient-reported outcomes of the early PTED cases are similar to the outcomes of later PTED cases, and similar to the outcomes of microdiscectomy cases. This study underlines the need for an experienced mentor for surgeons to safely adopt PTED.

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Section: ) Ptedmentioning

confidence: 99%

Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica

et al. 2022

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“…For these reasons, most surgeons prefer LA to GA. However, LA has such disadvantages as surgical anxiety ( 15 ) and stress reactions caused by anesthesia, immunosuppression, and inflammatory processes ( 16 ). Wang and co-authors have found that continuous epidural anesthesia has more advantages than LA in improving the immune function of patients undergoing the percutaneous endoscopic lumbar discectomy for lumbar disc herniation.…”

Section: Discussionmentioning

confidence: 99%

Transforaminal Endoscopic Discectomy Under General and Local Anesthesia: A Single-Center Study

et al. 2022

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Percutaneous spinal endoscopy is used for the treatment of disorders of the lumbar spine, as it has several advantages over traditional surgical methods. The performance of percutaneous spinal endoscopy is not possible without applying anesthesia methods. Two types (local and general) of anesthesia are used for percutaneous spinal endoscopy. Both, local and general anesthesia approaches contribute to safety in surgical procedures. Although it is believed that the method of local anesthesia has more benefits over general anesthesia, such as lowering the risk of postoperative neurological complications in a patient, the literature on the topic is inconclusive. The study aims to perform a comparative analysis of the two anesthesia methods using a prospective case-control design. Patients were divided into two groups: those who received local anesthesia (LA) (20 patients), and those who underwent general anesthesia (GA) (20 patients). As a result of the study, 40% of the patients experienced moderate pain and 5% of the patients experienced excruciating pain intraoperatively in the LA group. Although Visual Analog Scale and Oswestry Disability Index scores improved more rapidly in LA group, at the 12-month check-up point there was no significant difference between cases and controls. Nevertheless, there were postoperative complications such as nerve root injury in 10% of the patients; nausea, vomiting, dizziness, drowsiness in 15% of the patients in the GA group, and an insignificant or no such complications in patients of the LA group. The present study demonstrates that LA contributes to more positive short-term outcomes for patients as it facilitates nerve root damage prevention, and has no postoperative side effects on patients' well being.

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“…The full procedure has been published previously [ 15 ]. Local anesthesia was administered [ 19 ]. After insertion of a guidewire in the neuroforamen, conical rods are introduced followed by a drill to enlarge the neuroforamen.…”

Section: Methodsmentioning

confidence: 99%

“…15 Local anesthesia was administered. 19 After insertion of a guidewire in the neuroforamen, conical rods are introduced followed by a drill to enlarge the neuroforamen. Hereafter, an endoscope was introduced within the working channel using an 8-mm cannula.…”

Section: Percutaneous Transforaminal Endoscopic Discectomymentioning

confidence: 99%

Assessing the Learning Process of Transforaminal Endoscopic Discectomy for Sciatica

et al. 2022

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Objective: Percutaneous transforaminal endoscopic discectomy (PTED) is gaining popularity by both surgeons and patients as a less invasive treatment option for sciatica. Concerns, however, exist for its learning curve. No previous study has assessed the learning process of PTED. Hereby we present the learning process of 3 surgeons learning PTED.Methods: This analysis was conducted alongside a multicenter randomized controlled trial. After attending a cadaveric workshop, 3 spine-dedicated surgeons started performing PTED, initially under the supervision of a senior surgeon. After each 5 cases, and up to case 20, the learning process was evaluated using the validated questionnaires (objective structured assessment of technical skills [OSATS], global operative assessment of laparoscopic skills [GOALS]) and a 10-step checklist specifically developed for PTED.Results: In total, 3 learning curve surgeons performed a total of 161 cases. Based on self-assessment, surgeons improved mostly in the domains “time and motion,” “respect for tissue,” and “knowledge and handling of instruments.” Learning curve surgeons were more able to detect differences in performances on the OSATS than the senior surgeon. Based on the GOALS, the biggest improvements could be seen in “depth-perception” and “autonomy.” Based on the 10-item specific checklist, all surgeons performed all 10 steps by case 10, while only 1 surgeon performed all steps adequately by case 15.Conclusion: Based on these study results, PTED appears to be successfully adopted stepwise by 3 spine-dedicated surgeons. From 15 cases on, most steps are performed adequately. However, more cases might be necessary to achieve good clinical results. Validated tools are needed to determine the cutoff when a surgeon should be able to perform PTED independently.

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Quality of conscious sedation using dexmedetomidine during full-endoscopic transforaminal discectomy for sciatica: a prospective case series

Cited by 7 publications

References 24 publications

Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica

Surgeons Learning Curve of Transforaminal Endoscopic Discectomy for Sciatica

Transforaminal Endoscopic Discectomy Under General and Local Anesthesia: A Single-Center Study

Assessing the Learning Process of Transforaminal Endoscopic Discectomy for Sciatica

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