Abstract
Objective Nowadays, trans-sacral epiduroscopic laser decompression (SELD) using slender epiduroscopy and laser is one of the preferred options for minimally invasive treatment in lumbar disc diseases. However, SELD is still in the initial stages of the global field of spine surgery, and the clinical outcomes in patients with lumbar disc herniation are not established yet. Therefore, the authors investigated patients undergoing SELD to report the clinical results. Methods Between November 2015 and November 2018, a total of 82 patients who underwent single-level SELD for lumbar disc herniation with a minimum follow-up of 6.0 months were enrolled. A retrospective review of clinical data was conducted. Clinical outcomes were evaluated using the visual analogue scale (VAS) for low back and leg pain and Odom's criteria. Also, surgical outcomes, including complications and symptom recurrences, and radiological outcomes were analyzed. Results Low back pain and leg pain as determined by the VAS improved from an average of 5.43 ± 1.73 and 6.10 ± 1.67 to 2.80 ± 1.43 and 3.58 ± 2.08 at the final follow-up (p < 0.001). According to Odom's criteria, the success rate defined as excellent or good results at the final follow-up was 58.5%. There were no surgery-related complications such as neurologic deficits, infection, or epidural hematomas, except for transient mild paralysis in 3 patients and procedure-related nuchal pain in 2 patients. The rate of additional procedures was 17.0% (6 patients received revision surgery and 8 patients received an additional nerve block) during the follow-up. Conclusion Our findings showed that SELD for lumbar herniated disc disease achieved less favorable clinical outcomes compared with those of previous studies. Further study is needed to clarify the influencing factors on the clinical outcomes of SELD.
Highlights
Epiduroscopy, known as epidural spinal endoscopy, is defined as the percutaneous minimally invasive investigation of the epidural space with the assistance of a flexible endoscope through the sacral hiatus
We reviewed the clinical, surgical, and radiological outcomes of sacral epiduroscopic laser decompression (SELD) in patients with mild-tomoderate lumbar disc herniation with a follow-up of minimum 6 months
Twelve patients (14.6%) had a minor trauma history related to symptom aggravation, and 26 patients (31.7%) had a low back pain dominant symptom other than radicular leg pain. e median follow-up period was 23.0 months (Table 1)
Summary
Epiduroscopy, known as epidural spinal endoscopy, is defined as the percutaneous minimally invasive investigation of the epidural space with the assistance of a flexible endoscope through the sacral hiatus. It permits various clinical applications in the epidural space of the lumbosacral spine, such as epidural catheter placement and diagnosis, decompression of disc herniation, epidural adhesiolysis, delivery of epidural drug agents, and spinal cord stimulation electrode implants. Since the late 1960s, several pioneers, including Saberski, Ooi, Blomberg, Olsson, Holstrom, and Mollmann et al, developed the concept of spinal epiduroscopy through conducting human autopsies of the spine, and they reported on the clinical use of endoscopy via the sacral hiatus approach [3]. In the 1990s, researchers, including Leu and Shutse et al, reported on the clinical usefulness and outcomes of epiduroscopy for the treatment of spinal disease [4, 5]
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