scholarly journals Evaluation of the Efficacy of Epiduroscopic Laser Neural Discectomy in Lumbar Disc Herniations: Retrospective Analysis of 163 Cases- Evaluation of the Efficacy of ELND

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Ali Metin Ülgen ◽  
Serbülent Gökhan Beyaz ◽  
Mustafa Erkan Inanmaz ◽  
Fatih Şahin
Keyword(s):  
Lumbar Disc ◽  
Leg Pain ◽  
First Year ◽  
Complication Rates ◽  
Advanced Technique ◽  
Disc Herniations ◽  
Training And Research ◽  
Fiberoptic Device ◽  
A New Technique ◽  
University Training

Background. Epiduroscopy, or spinal endoscopy, is the visualisation of the epidural space using a percutaneous and minimally invasive imaging fiberoptic device. Recently, as a result of some studies, it has been reported that laser therapy with epiduroscopic laser neural discectomy (ELND) was applied during multiple lesions. Methods. In this study, ELND performed between January 2012 and July 2016 at the Algology Clinic of the Department of Anesthesiology and Reanimation, Sakarya University Training and Research Hospital, was examined retrospectively. The Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS) scores were recorded preoperatively, as well as after 2 weeks and 2, 6, and 12 months after the ELND. Results. According to the preoperative VAS and ODI scores, the decrease in postoperative 2nd week, 2nd, 6th, and 12th month VAS and ODI scores was significant p = 0.001 . Similarly, according to the postoperative 2nd week VAS and ODI scores, decrease in postoperative 6th and 12th VAS and ODI scores was significant p = 0.001 . Conclusions. As a result, ELND with Holmium: YAG laser, which is a new technique in patients with lumbar disc herniated low back and/or leg pain, can reduce VAS and ODI scores from 2 weeks without any complications that open surgery can bring with it. We believe that it is a useful and advanced technique in treatment of lumbar disc herniation and has low complication rates that provides maximum efficacy from the first year.

scholarly journals Comparison of Clinical Outcomes of Two-Level PELD and Foraminoplasty PELD for Highly Migrated Disc Herniations: A Comparative Study

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Xinbo Wu ◽  
Guoxin Fan ◽  
Shisheng He ◽  
Xin Gu ◽  
Yunfeng Yang
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Postoperative Complications ◽  
Clinical Outcomes ◽  
Nucleus Pulposus ◽  
Lumbar Disc ◽  
Leg Pain ◽  
Low Back ◽  
Satisfaction Rate ◽  
Disc Herniations

Objective. The aim of this study is to compare the clinical outcomes of two-level percutaneous endoscopic lumbar discectomy (PELD) and foraminoplasty PELD in treating highly migrated lumbar disc herniations. Methods. Patients with highly migrated lumbar disc herniations were enrolled from May 2014 to June 2016. Low back pain and leg pain were evaluated by the Visual Analog Scale (VAS), and functional outcomes were assessed with the Oswestry Disability Index (ODI). The satisfaction rate of clinical outcomes was assessed according to the modified MacNab criteria. In addition, the intraoperative duration and postoperative complications were also recorded. Results. Forty patients, 14 cases in two-level PELD group and 26 cases in foraminoplasty PELD group, were included. The VAS scores of low back pain (P=0.67) and leg pain (P=0.86), as well as the ODI scores (P=0.87), were comparative between two-level PELD and foraminoplasty PELD groups. The satisfaction rate of clinical outcomes based on the modified MacNab criteria in the two-level PELD group was equivalent to that in foraminoplasty PELD group (92.9% versus 92.3%, P=0.92). In addition, the intraoperative duration of two-level PELD group was longer than that of foraminoplasty PELD group (80.2 ± 6.6 min versus 64.1 ± 7.3 min, P<0.01). The postoperative complications in the two-level PELD group (postoperative dysesthesia: N = 1) were relatively fewer as compared to those in the foraminoplasty PELD group (postoperative dysesthesia: N = 1; recurrence: N = 1; nucleus pulposus residues: N = 1). Conclusions. Both two-level PELD and foraminoplasty PELD are safe and effective surgical procedures for the patients with highly migrated lumbar disc herniations. Moreover, the two-level PELD technique has merits in reducing the incidence of postoperative nucleus pulposus residue.

scholarly journals Early Postoperative Results after Removal of Cranially Migrated Lumbar Disc Prolapse: Retrospective Comparison of Three Different Surgical Strategies

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
C. Schulz ◽  
U. Kunz ◽  
U. M. Mauer ◽  
R. Mathieu
Keyword(s):  
Lumbar Disc ◽  
Leg Pain ◽  
Surgical Approaches ◽  
Postoperative Results ◽  
Retrospective Comparison ◽  
Interlaminar Approach ◽  
Disc Material ◽  
Disc Herniations ◽  
Group A ◽  
Group B

Background. To compare the early postoperative results of three surgical approaches to lumbar disc herniations that migrated cranially. Minimally invasive techniques such as the translaminar and endoscopic transforaminal approaches are utilized in patients with lumbar disc herniations to gain access to cranially located disc material and to avoid the potentially destabilizing resection of ligament and bone tissue, which is associated with an extended interlaminar approach.Methods. This retrospective study compares the postoperative pain and functional capacity levels of 69 patients who underwent an interlaminar (Group A,n=27), a translaminar (Group B,n=22), or an endoscopic transforaminal procedure (Group C,n=20).Results. Median VAS scores for leg pain decreased significantly from before to after surgery in all groups. Surgical revisions were required in thirteen cases (five in Group A, one in Group B, and seven in Group C;P=0.031). After six weeks, there were significant differences in back pain and functional outcome scores and in the results for the MacNab criteria but not in leg pain scores.Conclusions. The interlaminar and translaminar techniques were the safest and fastest ways of gaining access to cranially migrated disc material and the most effective approaches over a period of six weeks.

Unilateral surgical approach for lumbar disc herniation with contralateral symptoms

2012 ◽  
Vol 17 (2) ◽  
pp. 124-127 ◽  
Author(s):  
Taşkan Akdeniz ◽  
Tuncay Kaner ◽  
İbrahim Tutkan ◽  
Ali Fahir Ozer
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Surgical Approach ◽  
Lumbar Disc ◽  
Radicular Pain ◽  
Leg Pain ◽  
Motor Deficits ◽  
Disc Herniations ◽  
Herniated Lumbar Disc ◽  
Contralateral Symptoms

Object In most cases of lumbar disc herniation, the primary problem is usually limited to radicular pain due to nerve compression on the herniated side, which is generally limited to the side of operation. The aim of this study was to reevaluate the side of the surgical approach in a selected group of patients with leg pain and contralateral lumbar disc herniation. Methods Included in this study were a total of 5 patients with lumbar disc herniations who presented with contralateral symptoms and neurological signs. In all cases, patients underwent a microdiscectomy from the side ipsilateral to the herniated lumbar disc, the side contralateral to the motor deficits and leg pain. Results The symptoms and signs, to some extent, resolved during the immediate postoperative period. There were no postoperative complications. Conclusions The findings confirm that performing a laminotomy via the side of the herniation is sufficient for this group of patients.

scholarly journals Trans-Tubular Translaminar Microscopic-Assisted Nucleotomy for Lumbar Disc Herniations in the Hidden Zone

2021 ◽  
pp. 219256822199042
Author(s):  
Hamdan Abdelrahman ◽  
Sadat Seyed-Emadaldin ◽  
Branko Krajnovic ◽  
Ali Ezzati ◽  
Ahmed Shawky Abdelgawaad
Keyword(s):  
Lumbar Disc ◽  
Minimal Invasive ◽  
Leg Pain ◽  
Invasive Technique ◽  
Improvement Rate ◽  
Neurological Improvement ◽  
Minimally Invasive Surgical ◽  
Disc Herniations ◽  
The Mean

Study Design: A prospective cohort study in a high-flow spine center in Germany. Objectives: This study aimed to evaluate clinical outcomes and complications of the trans-tubular translaminar microscopic-assisted percutaneous nucleotomy in cases of cranially migrated lumbar disc herniations (LDH). Methods: Between January 2013 and January 2018, 66 consecutive patients with cranio-laterally migrated LDH were operated upon. The following outcome measures were evaluated: (1) Visual Analog Scale (VAS) for leg and back pain; (2) Oswestry Disability Index (ODI) and Macnab´s criteria. All patients were operated upon with trans-tubular Translaminar Microscopic-assisted Percutaneous Nucleotomy (TL-MAPN). Perioperative radiographic and clinical evaluations were reported. The mean follow-up period was 32 months. Results: The mean age was 59 years. L4/L5 was the commonest affected level (27 patients). The mean preoperative VAS for leg pain was 6.44 (±2.06), improved to 0,35 (±0.59) postoperatively. Dural injury occurred in 1 patient, treated with dural patch. Improved neurological function was reported in 41/44 Patients (neurological improvement rate of 93%) at the final follow up. There was a significant improvement in the mean ODI values, from 50.19 ± 4.92 preoperatively to 10.14 ± 2.22 postoperatively (P < 0.001). Sixty four out of 66 patients (96%) showed an excellent or good functional outcome according to Macnab´s criteria. No recurrent herniations were observed. Conclusion: The translaminar approach is a viable minimal invasive technique for cranially migrated LDH. The preservation of the flavum ligament is one of the main advantages of this technique. It is an effective, safe and reproducible minimally invasive surgical alternative in treatment of cranially migrated LDHs.

scholarly journals The Current State of Endoscopic Disc Surgery: Review of Controlled Studies Comparing FullEndoscopic Procedures for Disc Herniations to Standard Procedures

2013 ◽  
Vol 4;16 (4;7) ◽  
pp. 335-344
Author(s):  
Christof Birkenmaier
Keyword(s):  
Neuropathic Pain ◽  
Lumbar Disc ◽  
Standard Procedure ◽  
Clinical Results ◽  
Endoscopic Technique ◽  
Complication Rates ◽  
Disc Surgery ◽  
Standard Procedures ◽  
Disc Herniations ◽  
Microsurgical Techniques

Background: Neuropathic pain originating from spinal disc herniations is a very common problem. The majority of disc surgeries are performed to alleviate this pain once conservative measures and targeted injections have failed. Endoscopic spinal surgery is increasingly popular because it minimizes access trauma and hastens recovery from the intervention. This clinically oriented review evaluates controlled studies that investigate the clinical results and the complications of full-endoscopic lumbar and cervical procedures for symptomatic disc herniations in comparison to a microsurgical standard procedure. This review focuses exclusively on modern, full-endoscopic disc surgery irrespective of the specific access technique (e.g., interlaminar vs. transforaminal) and irrespective of the spinal region. Study Design: Comprehensive review of the literature. Objective: To assess the clinical outcomes and complication rates of full-endoscopic disc surgery compared to the microsurgical standard procedures. Methods: A PubMed and Embase search was performed, considering entries up to January 2013. All 504 results were screened and categorized. Only 4 randomized controlled trials (RCTs) and one controlled studies (CS) could finally be considered for evaluation. All 5 manuscripts were meticulously analyzed with regards to randomization mode, inclusion/exclusion criteria, clinical results, and complication rates. Results: Overall, the endoscopic techniques had shorter operating times, less blood loss, less operative site pain, and faster postoperative rehabilitation/shorter hospital stay/faster return to work than the microsurgical techniques. There were no significant differences in the main clinical outcome criteria between the endoscopic and the microsurgical techniques in any of the trials. All 5 studies had fewer complications with the endoscopic technique and this was statistically significant in 2 of the studies. One study showed a lower rate of revision surgeries requiring arthrodesis with the endoscopic technique. Limitations: All 5 studies that could be considered originate from experienced investigators and all 4 RCTs came from one group. This limits the transferability of their results to surgeons less experienced in endoscopic disc surgery. Conclusions: The studies show that full-endoscopic disc surgery can achieve the same clinical results in symptomatic cervical and lumbar disc herniations as the microsurgical standard techniques. This does not appear to come at the price of higher complication rates. Key words: Neuropathic pain, disc herniation, cervical, lumbar, endoscopic, endoscopy, review

Percutaneous Discectomy: An Alternative to Chemonucleolysis?

Neurosurgery ◽  
1983 ◽  
Vol 13 (5) ◽  
pp. 542-547 ◽  
Author(s):  
William A. Friedman
Keyword(s):  
Selection Process ◽  
Lumbar Disc ◽  
Radiographic Examination ◽  
Low Back ◽  
University Of Florida ◽  
Radiographic Findings ◽  
Percutaneous Discectomy ◽  
Disc Herniations ◽  
A New Technique ◽  
The University

Abstract At the University of Florida, a new technique for lumbar disc removal, called percutaneous discectomy, has been explored. This procedure may be performed under general or local anesthesia, frequently takes less than 15 minutes, and is generally bloodless. The patient selection process and the surgical technique are presented in detail. A total of nine patients have undergone percutaneous discectomy. Seven had clear radiculopathies with appropriate radiographic findings, and they all have had excellent relief of symptoms. Two patients presented with intractable low back pain, bilateral mechanical findings, and central disc herniations on radiographic examination. One experienced good relief and one did not. Three patients had several days of paraspinous spasm after the procedure, and one complained of a lower extremity dysesthetic sensation that persisted for several weeks after operation. Our early experience with percutaneous discectomy suggests that it is a technically easy procedure that may prove, in carefully selected cases, to be a viable alternative to other discectomy techniques.

Extreme-lateral lumbar disc herniations

1974 ◽  
Vol 41 (2) ◽  
pp. 229-234 ◽  
Author(s):  
A. F. Abdullah ◽  
Edward W. Ditto ◽  
Edward B. Byrd ◽  
Ralph Williams
Keyword(s):  
Back Pain ◽  
Clinical Picture ◽  
Lumbar Disc ◽  
Clinical Syndrome ◽  
Leg Pain ◽  
Sensory Loss ◽  
Lateral Bending ◽  
Content Type ◽  
Disc Herniations ◽  
Fine Print

✓ The authors believe that posterior lumbar disc herniations that occur far laterally (beneath, or beyond the facet) present a clinical picture and special problems of diagnosis different from those encountered with the usual herniations within the spinal canal. In a series of 204 consecutive disc operations, there were 24 “extreme-lateral” disc herniations at the second, third, or fourth lumbar interspace, none at the lumbosacral joint. When compared with the incidence of posterior herniations above the fourth interspace, it appeared that “extreme-lateral” herniations were responsible for the majority of second, third and fourth lumbar root compressions. The clinical syndrome is characterized by anterior thigh and leg pain, absent knee jerk, and sensory loss in the appropriate dermatome but also by the absence of back pain, typical back signs, or positive Lasegue's sign. Reproduction of pain and paresthesia by lateral bending to the side of the lesion is a reliable diagnostic sign. The authors report that myelography fails to disclose these lesions, while discography often proves helpful.

scholarly journals Outcomes of Discectomy in Young Adults With Large Central Lumbar Disc Herniations Presenting With Predominant Leg Pain

2019 ◽  
Vol 10 (4) ◽  
pp. 412-418
Author(s):  
Arvind G. Kulkarni ◽  
Sandeep Tapashetti
Keyword(s):  
Young Adults ◽  
Back Pain ◽  
Lumbar Disc ◽  
Young Patients ◽  
Visual Analogue Score ◽  
Leg Pain ◽  
Disc Herniations ◽  
The Mean ◽  
Poor Outcomes

Study Design: Retrospective cohort study. Objectives: Discectomy alone or discectomy with fusion have been 2 polarized options in the management of large lumbar disc herniations presenting with leg-dominant pain in young patients. The objective of the study was to evaluate the outcomes of discectomy in young patients with large central lumbar disc herniation (CLDH) presenting with predominant leg pain. Material and Methods: Young patients (<45 years) presenting with predominant leg pain and MRI confirmed diagnosis of CLDH between April 2007-January 2017 were included in the study. All patients underwent tubular microdiscectomy. Outcomes of surgery were evaluated using visual analogue score (VAS) for leg and back pain, Oswestry Disability Index (ODI), and Macnab’s criteria. Results: Ninety patients fulfilled the inclusion criteria. The mean age of patients was 34.9 years (range 19-45 years). Mean follow-up was 5.09 years (range 2-10 years). The incidence of CLDH in young adults was 30% and incidence among all “operated” lumbar disc herniations was 15.9%. The mean VAS for leg pain improved from 7.48 ± 0.9 to 2.22 ± 0.84 ( P < .05) and the mean ODI changed from 60.53 ± 7.84 to 18.33 ± 6.20 ( P < .05). Fifty-nine patients (65.6%) reported excellent, 25 patients (27.8%) reported good, 3 patients each (3.3%) as fair and poor outcomes respectively. Conclusion: Discectomy alone for CLDH with predominant leg pain is associated with high success rate and low need for a secondary surgical procedure. Patient selection in terms of leg-dominant pain may be the main attribute for lower incidence of recurrence, postoperative back-pain, and instability needing a secondary procedure. Minimally invasive discectomy may provide an added advantage of preserving normal spinal anatomy, thus minimizing the need for primary spinal fusion in these patients.

scholarly journals Full-Videoendoscopic Interlaminar Surgery for the Treatment of Lumbar Disc Herniations—A Series of 50 Cases

2017 ◽  
Vol 38 (01) ◽  
pp. 012-019
Author(s):  
Marco Alvarenga ◽  
Thiago da Rocha ◽  
Luis Marchi ◽  
Leonardo Correia
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Functional Disability ◽  
Lumbar Fusion ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Outpatient Setting ◽  
Complication Rates ◽  
Disc Herniations ◽  
The Mean

The present study aims to describe the results of full-videoendoscopic surgery through the interlaminar route for central lumbar disc herniation in a series of 50 cases in Brazil.This is a retrospective single-center study. With the aim of describing safety, the present study reports the complication and revision rates. The clinical results were collected with the visual analogue scale (VAS) and with the Oswestry Disability Index (ODI) (a questionnaire to evaluate functional disability) at the preoperative visit and at 6 months postsurgery.The average surgical time was 20 minutes (range: 9–40 minutes), and 100% of the procedures were performed in an outpatient setting. The mean VAS scores improved from 9.4 to 1.1 (p < 0.001), and the mean ODI scores decreased from 69 to 9 points in the last follow-up (p < 0.001). There was 1 case (2%) with hernia recurrence, 1 case with intraoperative root injury (2%), and 2 cases (4%) that required lumbar fusion due to a preexisting instability. No infections were observed.The full-videoendoscopic surgery is a modern option for treating lumbar disc herniation. In the present study, we have observed that the use of this technique for the removal of fragments affecting the vertebral canal presented satisfactory clinical results, low complication rates, and that it has demonstrated its feasibility in an outpatient setting without prolonged hospitalization.

Caudal Extension Graft of the Lower Lateral Cartilage: Technique and Aesthetic and Functional Results

2021 ◽  
Author(s):  
Juliano de Oliveira Sales ◽  
Wolfgang Gubisch ◽  
Rodrigo Ribeiro Ferreira Duarte ◽  
Aline Souza Costa Teixeira Moreno ◽  
Felipe Marques de Oliveira ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Age Groups ◽  
Functional Results ◽  
First Year ◽  
Lateral Cartilage ◽  
Lower Lateral Cartilage ◽  
Alar Retraction ◽  
Outcomes Evaluation ◽  
A New Technique ◽  
Extension Graft

AbstractHere we describe a new technique to deal with alar retraction, a highly undesirable imperfection of the nose. The procedure involves placing a caudal extension graft below the vestibular portion of the lower lateral cartilage (LLC) after its detachment from the vestibular skin. The graft is fixed to the cartilage and, subsequently, to the vestibular tissue. The present retrospective study included 20 patients, 11 females and 9 males, with a mean age of 28.90 years. Follow-up ranged from 1 to 18 months. Surgery improved alar notching to a smoother dome shape and nostril exposure was reduced in every patient. The caudal extension graft of the LLC contributed to rise in overall patient satisfaction, as revealed by the postoperative increase of the Rhinoplasty Outcomes Evaluation (ROE) mean score from 40.0 to 79.17 (p < 0.0001). It also contributed to and improved functional outcomes, as indicated by the decrease of the Nasal Obstruction Symptom Evaluation (NOSE) mean score from 52.75 to 13.25 (p = 0.0001). Sex did not affect the mean ROE and NOSE scores. Thus, increased patient satisfaction measured by the ROE is present in both sexes and at both age groups but it is better detected in the first year after surgery. Functional improvements analyzed with NOSE are best detected in patients aged ≥ 30 years and in follow-ups of 11 months. The caudal extension graft of the LLC technique described herein effectively and safely corrects alar retraction and the collapse of the nasal valve while filling the soft triangle.

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