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

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.

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.

Microsurgical infrapedicular paramedian approach for retrovertebral lumbar disc herniations

2005 ◽  
Vol 2 (1) ◽  
pp. 88-91 ◽  
Author(s):  
Nedal Hejazi
Keyword(s):  
Facet Joint ◽  
Lumbar Disc ◽  
Clinical Results ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Content Type ◽  
Clinical Benefits ◽  
Disc Herniations ◽  
Fine Print

✓ The author performed a microsurgical infrapedicular paramedian approach in 35 patients (23 men and 12 women) to remove herniated lumbar retrovertebral discs that did not have an apparent origin at either the superior or inferior disc level. The goal of this surgery was to minimize the bone resection, preserve the facet joint, and avoid the risk of secondary vertebral instability. The Macnab outcome classification was used to assess all patients who attended follow-up examination for at least 15 months. The clinical results were excellent or good in 34 (97%) of 35 cases. This minimally invasive lumbar spine technique resulted in minimal morbidity, excellent clinical benefits, and a long-term outcome without evidence of secondary segmental instability.

scholarly journals Treatment of Lumbar Disc Herniations by Interventional Fluoroscopy-Guided Endoscopy

2014 ◽  
Vol 20 (5) ◽  
pp. 538-546 ◽  
Author(s):  
Juergen Reul
Keyword(s):  
Lumbar Disc ◽  
Relevant Literature ◽  
Short Review ◽  
Short Hospital Stay ◽  
Disk Herniation ◽  
Lumbar Disk Herniation ◽  
Transforaminal Approach ◽  
Disc Herniations ◽  
Microsurgical Techniques ◽  
Rehabilitation Time

The neurointerventional transforaminal endoscopic approach to sequestered disk herniation is a minimally invasive alternative to established microsurgical techniques. In addition to those techniques approaching the nucleus like APLD, the transforaminal approach allows the removal of dislocated sequesters in the epidural space. The main steps of the procedure are fluoroscopy-guided, so a good experience with fluoroscopy based interventional techniques is helpful, but the technique has a significant learning curve. If familiar with the different steps, it allows nearly every lumbar disk herniation to be treated with a very short hospital stay and short rehabilitation time. The paper describes in detail the steps of the procedure, the difficulties and advantages and gives a short review of the relevant literature.

scholarly journals Revision after failed discectomy

2019 ◽  
Vol 29 (S1) ◽  
pp. 14-21
Author(s):  
Christoph Mehren ◽  
Lorenz Wanke-Jellinek ◽  
Andreas Korge
Keyword(s):  
Lumbar Disc ◽  
Clinical Results ◽  
Scar Tissue ◽  
Common Complication ◽  
Disc Herniations ◽  
Clear Guideline ◽  
Supplementary Material ◽  
Clinical Register ◽  
Recurrent Lumbar Disc Herniation

Abstract Purpose Recurrent lumbar disc herniation is the most common complication after discectomy. Due to the altered anatomy with the presence of scar tissue, the surgical revision of already operated patients could be a surgical challenge. Methods We describe the microsurgical revision technique step by step with the evaluation of our own clinical results in comparison with primary lumbar disc surgeries. The clinical data are based on a clinical register with 2576 recorded primary surgeries (PD) and 592 cases of revisions (RD) with 12- and 24-month follow-up (FU). The intraoperative dura lesion rates of the surgeries between 2016 and 2018 were recorded retrospectively. Data from 894 primary disc surgeries and 117 revisions were evaluated. Results The ODI and the VAS for leg and back pain improved in both groups significantly with slightly inferior outcome of the revision group. The ODI improved from 46.3 (PD) and 45.9 (RD), respectively, to 12.6 (PD) and 22.9 (RD) at the 24-month FU. The VAS dropped down as well in both group [VAS back: 47.8 (PD) and 43.9 (RD) to 19.9 and 32.2 at the 24-month FU; VAS leg: 62.9 (PD) and 65.5 (RD) to 15.6 and 26.8 at the 24-month FU]. During the primary interventions, we observed 1.5% (11/894) and during revisions 7.7% (9/117) of dura lesions. Conclusions There is no clear guideline for the surgical treatment of recurrent disc herniations. In most cases, a pure re-discectomy is sufficient and can be performed safely and effectively with the help of a microscope. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.

Late results of cervical disc surgery

1976 ◽  
Vol 45 (2) ◽  
pp. 203-210 ◽  
Author(s):  
William Beecher Scoville ◽  
George J. Dohrmann ◽  
Guy Corkill
Keyword(s):  
Posterior Approach ◽  
Lumbar Disc ◽  
Late Results ◽  
Cord Compression ◽  
Cervical Disc ◽  
Spinal Level ◽  
Content Type ◽  
Disc Surgery ◽  
Disc Herniations ◽  
Cervical Disc Surgery

✓ Late results of cervical disc surgery have been reported and statistically studied in 383 cases; 83% were lateral discs, 13% were central spondylosis discs, and 4% central soft discs. Central spondylosis occurred at a higher spinal level, and caused cord compression with or without weakness of the hands, but no pain. A posterior approach was used in all lateral discs, and either an anterior or a posterior approach, with or without fusion, for central discs. Preoperative myelography was always done and is recommended postoperatively in central disc surgery to evaluate the results. Our results were good to excellent in 95% of lateral discs, in 64% of central spondylosis discs, and in an unexpected 91% of 11 cases of central soft discs. There were no recurrences and no serious complications, although 20% developed other cervical or lumbar disc herniations.

scholarly journals Cost-Effectiveness of Percutaneous Automated Lumbar Nucleotomy

1999 ◽  
Vol 5 (1) ◽  
pp. 35-42 ◽  
Author(s):  
R. Dullerud ◽  
H. Lie ◽  
B. Magnæs
Keyword(s):  
Cost Effectiveness ◽  
Surgical Treatment ◽  
Lumbar Disc ◽  
Invasive Procedure ◽  
Cost Effective ◽  
Clinical Results ◽  
Complication Rates ◽  
Success Rates ◽  
One Year ◽  
The Cost

This study was conducted in order to evaluate the cost-effectiveness of percutaneous automated lumbar nucleotomy in comparison with traditional macro-procedure discectomy in the treatment of herniated discs. Sixty-eight patients undergoing surgical procedures and 90 treated with nucleotomy were consecutively included. Both cohorts were assessed pre-operatively and at regular intervals for one year or more after treatment by independent observers, using a clinical overall scoring system (COS) with 0 being the best attainable result and 1000 the poorest conceivable status of the patients. There were better clinical results after surgery with 78% successes after one year compared to 62% after nucleotomy. By including subsequent operations and re-operations after failure to respond to the primary treatment, the success rates rose to 79% and 77%, respectively. The cost of surgical treatment was calculated to USD 6.119 per patient and the cost of a nucleotomy procedure was USD 1.252. Owing to an almost five times higher price of surgery than nucleotomy, the latter turned out to be 2.7 to 3.9 times more cost-effective, depending on whether secondary treatment was included or not. Due to the minimal difference in final outcome between the groups, however, the marginal cost per extra success in patients primarily treated with surgery was as high as USD 205.850. The study concludes that nucleotomy, as a mini-invasive procedure with low complication rates and the potential of a quick recovery, is more cost-effective than traditional surgical treatment for lumbar disc herniation.

scholarly journals Ten-Step Minimally Invasive Spine Lumbar Decompression and Dural Repair Through Tubular Retractors

2017 ◽  
Vol 13 (2) ◽  
pp. 232-245 ◽  
Author(s):  
Mohamed Abdelatif Boukebir ◽  
Connor David Berlin ◽  
Rodrigo Navarro-Ramirez ◽  
Tim Heiland ◽  
Karsten Schöller ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Lumbar Disc ◽  
Surgical Techniques ◽  
Synovial Cyst ◽  
Clinical Results ◽  
Complication Management ◽  
Lumbar Degenerative Disease ◽  
Dural Repair ◽  
Microsurgical Techniques ◽  
Minimally Invasive Spine

Abstract BACKGROUND: Minimally invasive spine (MIS) surgery utilizing tubular retractors has become an increasingly popular approach for decompression in the lumbar spine. However, a better understanding of appropriate indications, efficacious surgical techniques, limitations, and complication management is required to effectively teach the procedure and to facilitate the learning curve. OBJECTIVE: To describe our experience and recommendations regarding tubular surgery for lumbar disc herniations, foraminal compression with unilateral radiculopathy, lumbar spinal stenosis, synovial cysts, and dural repair. METHODS: We reviewed our experience between 2008 and 2014 to develop a step-by-step description of the surgical techniques and complication management, including dural repair through tubes, for the 4 lumbar pathologies of highest frequency. We provide additional supplementary videos for dural tear repair, laminotomy for bilateral decompression, and synovial cyst resection. RESULTS: Our overview and complementary materials document the key technical details to maximize the success of the 4 MIS surgical techniques. The review of our experience in 331 patients reveals technical feasibility as well as satisfying clinical results, with no postoperative complications associated with cerebrospinal fluid leaks, 1 infection, and 17 instances (5.1%) of delayed fusion. CONCLUSION: MIS surgery through tubular retractors is a safe and effective alternative to traditional open or microsurgical techniques for the treatment of lumbar degenerative disease. Adherence to strict microsurgical techniques will allow the surgeon to effectively address bilateral pathology while preserving stability and minimizing complications.

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