Full-endoscopic Interlaminar Discectomy Research Articles

A Review of Full-endoscopic Interlaminar Discectomy for Lumbar Disc Disease: A Historical and Technical Overview

Journal of Minimally Invasive Spine Surgery & Technique (JMISST) is the official journal of the Korean Minimally Invasive Spine Surgery Society (KOMISS) for the publication of research results about minimally invasive spinal surgery (MISS), including studies in spinal endoscopic surgery, minimally invasive procedure for degenerative spine disease, pain intervention, and minimally invasive surgery for spinal fusion or spine trauma, neuroscience, neurology, molecular biology and biomechanics etc. Articles with helpful information for MISS such as reports of rare cases or technical review of special devices or equipment are also available

A Review of Full-endoscopic Interlaminar Discectomy for Lumbar Disc Disease: A Historical and Technical Overview

A Review of Full-endoscopic Interlaminar Discectomy for Lumbar Disc Disease: A Historical and Technical Overview

Full endoscopic interlaminar discectomy (FEID) for recurrent lumbar disc herniation: surgical technique, clinical outcome, and prognostic factors.

The objective of this study is to determine the effectiveness and prognostic factors of revisional full endoscopic interlaminar discectomy (FEID) for recurrent herniation after conventional open disc surgery. The major concerns of the repeated discectomy for recurrent lumbar disc herniation (RLDH) are the epidural scar and postoperative segmental instability. Compared to open discectomy, endoscopic method has advantages of less tissue traumatization, clearer visualization and better tissue identification. With the improvement of endoscopic technique and instrument, the problems related to adhesive scar tissues or postoperative instability could be overcome. From June 2014 to December 2016, FEID was performed in consecutive 24 patients for RLDH. The age ranged from 25 to 60 years (mean 44.6 years). The level operated was L5-S1 in 16 cases and L4-5 in 8 cases. To avoid injury to the neural tissue, we started with the bony structure. A small part of facet or lamina might be resected in severe stenotic or adhesive condition. Aggressive separation of the scar from the neural tissue might lead to dural tear and should be avoided. The herniated disc material was removed after neural tissue had been clearly identified and protected. The follow-up period was at least 24 months. The visual analog scale (VAS) for leg pain and back pain, and Oswestry disability index (ODI) showed significant improvement after treatment. Excellent or good outcome by the modified Macnab's criteria was obtained in 22 of 24 patients at two years follow-up. Excellent outcome was noted in 100 percent patients younger than 50 years. Small durotomy occurred in 2 patients and no visible cerebrospinal fluid (CSF) leakage was detected despite repair was not performed. Two additional surgery was performed including one repeated FEID for re-recurrence of disc herniation and one fusion surgery for postoperative back pain. FEID is a safe and effective alternative for recurrent disc herniation. The successful rate was greater than 90 percent, especially in the younger patients with the advantages of early recovery and no need for fusion.

Modified Full-Endoscopic Interlaminar Discectomy via an Inferior Endplate Approach for Lumbar Disc Herniation: Retrospective 3-Year Results from 321 Patients

Percutaneous endoscopic interlaminar discectomy (PEID) is a widely used minimally invasive procedure that shows satisfying outcomes for the treatment of L5-S1 and even L4-5 disc herniation. PEID can be divided into direct and indirect approaches according to the established method of the working channel. The direct approach mainly uses the puncture needle directly through the intervertebral space into the intervertebral disc under indirect vision and insertion of the guidewire into the puncture needle to guide the dilator and into the working channel to retract the ligamentum flavum, dural sac, and nerve roots. This approach requires a skilled puncture technique, given the high risk of damage to the nerve roots and dural sac. Therefore, we improved this interlaminar access procedure, placing the puncture target at the inferior endplate and performing preoperative epidurography to expose the spinal nerve roots and dural sac after the puncture needle was passed through the ligamentum flavum. We then positioned the puncture needle at the posterior edge of the superior centrum. Finally, we inserted the working sleeve for the operation. This approach is convenient and effectively reduces the learning curve andintraoperative complications. Here we introduce theprocedure and report the safety and efficacy of full-endoscopic interlaminar discectomy via an inferior endplate approach for the treatment of lumbar disc herniation. We performed full-endoscopic interlaminar discectomy via the inferior endplate approach in 321 patients who met our inclusion criteria between May 2014 and May 2017. All operations were completed under local anesthesia. Under fluoroscopic guidance, we performed epidurography to expose the spinal nerve roots and dural sac. The working sleeve and endoscope were then introduced into the inferior endplate of the superior centrum. Herniated disc material was removed using forceps and a laser under clear endoscopic visualization. We retrospectively evaluated the 321 patients with more than 30 months (range, 12-48 months) of follow-up. The therapeutic effects were assessed using scores of the visual analog scale (VAS), Oswestry disability index (ODI), Macnab standard, and infrared thermal imaging. The mean VAS score for radicular pain improved from 6.3 ± 1.01 preoperatively to 1.01 ± 0.35 at the final follow-up (P < 0.01). The mean ODI score improved from 85.5 ± 12 preoperatively to 12.4 ± 3.7 at the final follow-up (P < 0.01). According to the MacNab standard, the excellent and good outcome scores were 96.5%. The infrared thermal imaging scores indicated significantly improved skin temperature of both lower extremities at 1 week after surgery compared with the preoperation temperature (P < 0.01). The inferior endplate approach for percutaneous endoscopic interlaminar discectomy provides a safe and effective alternative for the treatment of lumbar disc herniation.

WITHDRAWN: Modified Full-Endoscopic Interlaminar Diskectomy via an Inferior End Plate Approach for Lumbar Disk Herniation: Retrospective 3-Year Results from 321 Patients

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Endoscopic Surgery for Recurrent Disc Herniation After Microscopic or Endoscopic Lumbar Discectomy.

To determine the feasibility and efficacy of full endoscopic interlaminar discectomy (FEID) for recurrent disc herniation. This retrospective single-center study included 60 patients. Among them, 36 who previously had microdiscectomy underwent revisional FEID (MD group), and 24 who previously had FEID underwent revisional FEID (FEID group). In addition to general parameters, the following measurement tools were used: visual analog scale (VAS) and Oswestry disability index (ODI) questionnaire. No statistically significant difference was observed in length of hospitalization, time to return to work, complications, and recurrences between the two groups. Both the FEID and MD groups had a significant decrease in postoperative VAS and ODI scores. The mean operation time was shorter in the FEID group than in the MD group, and the result was significantly different (p < 0.05). During the 36-month follow-up, no significant differences were observed in postoperative VAS and ODI scores between the two groups. Moreover, none of the patients developed complications correlated to surgery. However, three patients with a previous history of microdiscectomy or endoscopic discectomy had recurrence despite revisional endoscopic surgery. Percutaneous revisional full endoscopic lumbar disc surgery is a safe and effective procedure that does not cause additional structural damage. Full endoscopic technique can be used safely for recurrent disc herniations regardless if a patient underwent microscopic or endoscopic surgery.

Early Experience of Full-Endoscopic Interlaminar Discectomy for Adolescent Lumbar Disc Herniation with Sciatic Scoliosis

Full-endoscopic interlaminar discectomy (FEID) has achieved satisfactory outcome in adolescent lumbar disc herniation (ALDH). Sciatic scoliosis is found to be a common presentation in ALDH. However, few reports are focused on the influences of sciatic scoliosis on ALDH and the prognosis of sciatic scoliosis after FEID. This study aims to evaluate the clinical and radiological results of FEID in the treatment of ALDH with sciatic scoliosis and to identify the effects of sciatic scoliosis on complication and recurrence. A retrospective study. An inpatient surgery center. A series of cases of patients under age 20 with single-level ALDH that underwent FEID between January 2010 and December 2014 were retrospectively analyzed. The patients were divided into 2 groups according to if they had scoliosis or not. Clinical outcomes were evaluated using a visual analog scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI) for the functional assessment, and modified Macnab criteria for the patient satisfaction. Radiological parameters of the scoliosis group such as Cobb angle, CVSL-max, and CVSL-C7 were statistically analyzed. No significant differences were found between both groups in terms of the mean operative time, the mean length of hospital stay, complications, and recurrences (P > 0.05). VAS and ODI scores were significantly improved in both groups (P < 0.05). However, there were no statistically significant differences between the 2 groups in VAS, ODI, and modified MacNab criteria (P > 0.05). For the scoliosis group, significant improvements were observed in the postoperative sagittal and coronal alignment parameters (P < 0.05). This was a retrospective study with a relatively small sample size. Additionally, the length of follow-up was short. The application of FEID in the treatment of ALDH could achieve satisfactory clinical and radiological outcomes. Sciatic scoliosis was corrected spontaneously without increasing the risk of complication and recurrence. Adolescent lumbar disc herniation, full-endoscopic interlaminar discectomy, sciatic scoliosis, recurrence.

ENDOSCOPIC INTERLAMINAR DISCECTOMY. USE OF SWINE CADAVERS AS A TRAINING MODEL

ABSTRACT Objective: To analyze the possibility of using cadavers of pigs for training in endoscopic interlaminar discectomy. Methods: Five young pigs were used. The necessary instruments and equipment were used, and the endoscopic transforaminal and interlaminar percutaneous approach was performed at the L7-S1 level. A specialist surgeon performed the procedure. The points of entry, needle angulation, and subjective technical difficulties indicated by the surgeon were analyzed. Results: The mean weight of pigs was 42.2 kg. The posterolateral (transforaminal) entry point was, on average, 6.28 cm from the midline at an angulation of 32.8°. The posterior (interlaminar) entry point was on average 1.82 cm. Full-endoscopic interlaminar discectomy was possible in all animals of the sample. The structures described in the literature were visible endoscopically in 100% of the models. Conclusions: The demonstrated benefits and increased indications of endoscopic lumbar surgery created the need to establish safer and more efficient training processes. The authors raise the possibility of using experimental models to develop technical skills in endoscopy via interlaminar approach. The use of teaching tools such as animal models constitutes a new learning technique and give more confidence to surgeons. The use of cadavers of pigs, obtained according to ethics, avoids the use of human cadavers, and minimizes the development of the learning curve on patients.

Clinical Outcome of Full-endoscopic Interlaminar Discectomy for Single-level Lumbar Disc Herniation: A Minimum of 5-year Follow-up

Background: Full-endoscopic interlaminar discectomy (FEID) is widely applied for the treatment of lumbar disc herniation (LDH) and satisfactory short-term outcomes have been achieved. However, the long-term evaluation for this technique is still lacking, especially the comparison between FEID and microendoscopic discectomy (MED). Objective: To evaluate the clinical outcome of FEID technique in comparison with MED for singlelevel LDH with a minimum of 5-year follow-up. Study Design: Retrospective study. Setting: Inpatient surgery center. Methods: A total of 152 patients with single-level LDH located at either L4-L5 or L5-S1 who underwent either FEID or MED from August 2008 to April 2011 at our hospital were enrolled in this study. General parameters including operative time, length of hospital stay, mean time to return to work, complications, and recurrences were recorded. Clinical outcomes were evaluated using visual analog scale (VAS) for low back and leg pain, Oswestry Disability Index (ODI) for functional assessment, and modified MacNab criteria for patient satisfaction. Results: At the final follow-up, the VAS of leg and back pain decreased from 7.6 ± 1.6 and 3.1 ± 2.2 points preoperatively to 1.6 ± 1.2 and 1.7 ± 0.9 at the final follow-up, respectively (P &lt; 0.05). The ODI score was 69.5% ± 10.5% preoperatively, and declined to 21.8% ± 7.0% at the final follow-up (P &lt; 0.05). VAS, ODI, and modified MacNab criteria of the FEID group were improved compared to the control group though there were no statistically significant differences between the 2 groups. Limitations: This was a retrospective study with a relatively small sample size. Additionally, this study contained only clinical outcomes, without long-term radiological outcomes. Conclusions: The application of FEID achieved similar satisfactory long-term clinical outcomes for the surgical treatment of LDH as MED. However, compared with MED, FEID exhibits advantages including less operation time, shorter hospital stay, and faster postoperative recovery. Key words: Lumbar disc herniation, full-endoscopic interlaminar discectomy, microendoscopic disectomy, long-term Pain Physician 2017

Full-endoscopic interlaminar discectomy for herniation at L3–4 and L4–5: Technical note

Summary Full-endoscopic interlaminar discectomy (FEILD) for herniations above the level of L5–S1 has been the subject of few studies. FEILD was performed between July 2009 and September 2009 on three patients with symptomatic lumbar disc herniations above the level of L5–S1. The patients were 29 years, 67 years, and 71 years of age, and had experienced symptoms for 2 months, 12 months, and 6 months, respectively. After the operation, the mean visual analog scale score decreased from 6.6 to 1.3 and the mean Oswestry Disability Index score decreased from 20.3 to 3. In conclusion, FEILD is feasible for the treatment of disc herniations at L3–4 and L4–5 and offers good functional outcomes in terms of visual analog scale and Oswestry Disability Index. To achieve a good outcome, a beginner should first master open microscopic lumbar discectomy and then start with observing procedures, assisting at procedures, and practicing FEILD on cadavers.