Treatment of Upper Lumbar Disc Herniation with a Transforaminal Endoscopic Technique

Wang, Zuowei; Jian, Fengzeng; Wu, Hao; Wang, Xingwen; Wang, Kai; Duan, Wanru; Liu, Zhenlei; Chen, Zan

doi:10.3389/fsurg.2022.893122

Cited by 4 publications

(4 citation statements)

References 15 publications

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“…Wang et al . demonstrated the average operative time in the PETD was 80.4 ± 18.0 min and the fluoroscopy occurrences averaged 17.1 ± 8.7 times, 22 and the average operative time in the MPEID group was 65.41 ± 12.61 min, with fluoroscopy occurrences averaging 6.47 ± 1.00 times. The fluoroscopy usage and operative time were both significantly decreased in the MPEID group.…”

Section: Discussionmentioning

confidence: 90%

Modified Percutaneous Endoscopic Interlaminar Discectomy through the Near‐spinous Process Approach for L4/5 Disc Herniation: A Retrospective Clinical Study

Xu,

Yuan,

et al. 2024

Orthopaedic Surgery

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ObjectiveCompared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain, so it has been widely used in the field of spinal surgery. However, it still has the defect of intraoperative fluoroscopy occurrences, complications, and even the risk of damage to the spinal cord and nerve. This study aims to compare the clinical efficacy of modified percutaneous endoscopic interlaminar discectomy (MPEID) with percutaneous endoscopic transforaminal discectomy (PETD) in treating L4/5 lumbar disc herniation (LDH) and to evaluate the effectiveness and safety of MPEID.MethodsThirty‐four L4/5 LDH patients treated at the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were studied retrospectively. Seventeen underwent MPEID and seventeen PETD. Variables analyzed included demographics, operative duration, intraoperative fluoroscopy occurrences, and surgical outcomes. Effectiveness was evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. Lumbar Magnetic Resonance Imaging (MRI) was used to assess radiological outcomes. A paired t‐test was performed to compare intragroup pre‐ and postoperative clinical data, VAS, and ODI scores.ResultsThe average operative time in PETD group was 91.65 ± 14.04 min, and the average operative time in MPEID group was 65.41 ± 12.61 min (p < 0.001). In PETD group, the fluoroscopy occurrences averaged 9.71 ± 1.05 times, with fluoroscopy occurrences averaging 6.47 ± 1.00 times (p < 0.001) in MPEID group. At 12 months follow‐up, the clinical effect showed significant improvement in both two groups. The MPEID group showed a decrease in average VAS‐back score from 5.41 ± 2.18 to 1.76 ± 1.09 (p < 0.001) and VAS‐leg score from 6.53 ± 1.66 to 0.82 ± 0.64 (p < 0.001). The ODI scores decreased from 51.35 ± 10.65 to 11.71 ± 2.91 (p < 0.001). In the PETD group, the VAS‐back score decreased from 4.94 ± 1.98 to 2.06 ± 1.25 (p < 0.001), VAS‐leg score from 7.12 ± 1.73 to 1.12 ± 0.60 (p < 0.001), and ODI scores from 48.00 ± 11.62 to 12.24 ± 2.56 (p < 0.001). According to the modified MacNab criteria, MPEID had 15 excellent and two good results; PETD had 12 excellent and 5 good (p = 0.23). No nerve root injuries, dural tears, or significant complications were reported.ConclusionMPEID and PETD effectively treat L4/5 LDH, with MPEID showing shorter operative times and fewer fluoroscopies. Furthermore, the MPEID group can provide excellent clinical efficacy as the PETD group in the short term.

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Section: Discussionmentioning

confidence: 90%

Modified Percutaneous Endoscopic Interlaminar Discectomy through the Near‐spinous Process Approach for L4/5 Disc Herniation: A Retrospective Clinical Study

Xu,

Yuan,

et al. 2024

Orthopaedic Surgery

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“…Lumbar disc herniation (LDH) is the most common spinal disorder and the most common indication for spinal surgery [1]. Upper lumbar disc herniation (ULDH) accounts for 1-10% of all LDH [2][3][4][5][6][7]. The unclear definition of ULDH is a reason for the wide variation in its incidence.…”

Section: Introductionmentioning

confidence: 99%

“…Some authors considered the upper lumbar discs to be located at L1-L2 or L2-L3 [2,4,5,[8][9][10]. Other authors expanded the definition to T12-L1 and L3-L4 [3,6,7,11,12]. Upper lumbar discs were defined as L1-L2 and L2-L3 levels due to the specific anatomical characteristics and less favorable clinical outcome of L1-L2 and L2-L3 levels of LDH [4,13].…”

Section: Introductionmentioning

confidence: 99%

Percutaneous transforaminal endoscopic discectomy for Upper Lumbar Disc Herniation versus lower lumbar disc herniation: clinical outcomes and technical consideration

Yuan,

Mei,

Zang

et al. 2024

BMC Musculoskelet Disord

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Background Upper lumbar disc herniation (ULDH) accounts for 1-10% of all lumbar disc herniations (LDH). This study aimed to evaluate the clinical characteristics and outcomes of patients with ULDH who underwent percutaneous transforaminal endoscopic discectomy (PTED) compared with those with lower LDH. Methods 60 patients with ULDH or L4–L5 LDH treated with PTED between May 2016 and October 2021. MacNab criteria, visual analog scale (VAS) of back pain and leg pain, and Japanese Orthopedic Association (JOA) were evaluated before and after surgery. Results In the L1–L3 group, 59.1% of the patients had a positive femoral nerve tension test, and 81.8% of the patients had a sensory deficit. Both groups showed significant improvements in VAS scores for low back and leg pain, and JOA scores postoperatively. No significant differences in the degree of improvement were observed between the two groups. The excellent/good rate was 81.8% in the L1–L3 group and 84.2% in the L4–L5 group, showing no significant difference. Conclusion PTED has comparable efficacy in treating ULDH as it does in treating lower LDH, it is a safe and effective treatment method for ULDH.

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“…Full endoscopic lumbar discectomy (FELD) has evolved rapidly in the treatment of degenerative lumbar spine disease [1][2][3][4]. Compared with traditional open surgery, FELD has evident advantages.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Pain Management after Full Endoscopic Lumbar Discectomy: An Observational Study

et al. 2022

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Background: Surgical incision pain, rebound pain, and recurrence can manifest themselves in different forms of postoperative pain after full endoscopic lumbar discectomy (FELD). This study aims to evaluate various postoperative pains after FELD and summarize their characteristics. Methods: Data about the demographic characteristics of patients, pain intensity, and functional assessment results were collected from January 2016 to September 2019. Clinical outcomes including Oswestry Disability Index (ODI) and visual analog scale (VAS) scores, were obtained. Results: A total of 206 patients were enrolled. ODI and VAS of the patients significantly decreased after FELD at 12-month follow-up. A total of 193 (93.7%) patients had mild surgical incision pain after FELD and generally a VAS < 4, and it mostly resolved on its own within 3 days. A total of 12 (5.8%) patients experienced rebound pain, which was typically characterized by pain (mainly leg pain with or without back pain), generally occurring within 2 weeks after FELD and lasting < 3 weeks. The pain levels of rebound pain were equal to or less than those of preoperative pain, and generally scored a VAS of < 6. The recurrence rate was 4.4%. Recurrence often occurs within three months after surgery, with the pain level of the recurrence being greater than or equal to the preoperative pain. Conclusions: Different types of postoperative pain have their own unique characteristics and durations, and treatment options are also distinct. Conservative treatment and analgesia may be indicated for rebound pain and surgical incision pain, but recurrence usually requires surgical treatment.

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Treatment of Upper Lumbar Disc Herniation with a Transforaminal Endoscopic Technique

Cited by 4 publications

References 15 publications

Modified Percutaneous Endoscopic Interlaminar Discectomy through the Near‐spinous Process Approach for L4/5 Disc Herniation: A Retrospective Clinical Study

Modified Percutaneous Endoscopic Interlaminar Discectomy through the Near‐spinous Process Approach for L4/5 Disc Herniation: A Retrospective Clinical Study

Percutaneous transforaminal endoscopic discectomy for Upper Lumbar Disc Herniation versus lower lumbar disc herniation: clinical outcomes and technical consideration

Postoperative Pain Management after Full Endoscopic Lumbar Discectomy: An Observational Study

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