Discectomy Research Articles

Erector spinae plane block versus local infiltration anaesthesia for transforaminal percutaneous endoscopic discectomy: A prospective randomised controlled trial

BackgroundAround 60%–80% of the population suffers from back pain, making it one of the most common health complaints. Transforaminal percutaneous endoscopic discectomy (TPED) is an effective treatment for low back pain that can be performed using different anaesthesia techniques. Our primary objective was to test the hypothesis that bilateral Erector spinae plane block (ESP) plus sedation is equally effective as traditional local infiltration anaesthesia plus sedation in TPED. Materials and methodsFifty-two patients undergoing TPED were randomly assigned to 2 groups: G1 – intravenous sedation with local infiltration anaesthesia; G2 – intravenous sedation with bilateral ESP. Primary outcome: volume of fentanyl and propofol administered during surgery. Secondary outcomes: adverse events during sedation reported using the World Society of Intravenous Anaesthesia (SIVA) adverse sedation event tool, level of postoperative sedation measured on the Richmond Agitation-Sedation Scale (RASS), intensity of postoperative pain on a visual analogue scale (VAS), mechanical pain threshold (MPT) measured with von Frey monofilaments on both lower extremities, patient satisfaction with analgesia on 5-point Likert scale. ResultsVolume of fentanyl, propofol, and level of postoperative sedation was significantly lower in G2 (p < 0.001). There was no difference between groups in intensity of pain, patient satisfaction with analgesia, and mechanical pain threshold after surgery. There were no adverse events in G2, but in G1 2 patients presented minimal risk descriptors, 5 presented minor risk descriptors, and 1 presented sentinel risk descriptors that required additional medication or rescue ventilation. ConclusionsThe ESP was equal to local infiltration anaesthesia in terms of intensity of pain, mechanical pain threshold after surgery, and patient satisfaction; however, ESP reduced the volume of intraoperative fentanyl and propofol, thereby reducing the adverse effects of sedation.

Evaluation of Outcomes of Percutaneous Endoscopic Discectomy in the Treatment of Patients with Lumbar Degenerative Disc Herniation

Background Lumbar discectomy is one of the most common operations performed worldwide for lumbarrelated symptoms. During the latter half of the 19th century, more techniques were developed to remove the herniated disc with minimal invasiveness. Aim and objectives The aim of this study was to analyze the safety and efficacy of percutaneous endoscopic discectomy in the treatment of lumbar degenerative disc herniation for adult patients. Subjects and methods A systematic review was conducted, including adult patients (&amp;gt; 18 years and less than 80 years old) with surgical treatment of lumbar radiculopathy secondary to degenerative herniated discs. Results results revealed that mean preoperative VAS was 6.05 which improved post operation to 1.35. Mean preoperative ODI score was 56.5 which decreased to 14.2 post operation, and SF-36 physical was used by four studies and mean preoperative score was 42.07 which increased to 76.2 post operation. SF-36 mental score used by three studies with mean preoperative score was 41.08 which increased post operation to 65.5. Conclusion PELD appears to be an effective intervention for LDH, as it has a small amount of intraoperative blood loss, short postoperative hospital stay, and good clinical and functional outcomes. It needs more training, as it has a long learning curve.

Comparative analysis of patient-reported outcomes after percutaneous endoscopic lumbar discectomy between transforaminal and interlaminar approach: a minimum twoyear follow-up.

Percutaneous endoscopic lumbar discectomy has been increasingly used in the treatment of lumbar disc herniation. However, there is no consensus on which method would be more effective between the transforaminal and interlaminar approach. To compare clinical outcomes, patient satisfaction rate, reoperation rate, and residual symptoms between percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID). A comparative, retrospective, controlled trial. The study was conducted at the Department of Orthopaedics at a local hospital. From January 2015 to September 2020, consecutive patients who underwent PETD or PEID treatment for lumbar disk herniation (LDH) at the L5/S1 level in our department were retrospectively collected. Baseline data including age, gender, body mass index (BMI), smoking status, alcohol drinking, clinical symptoms, physical examination, and radiographic characteristics were documented. During the two to threeyear follow-up periods, patients were evaluated clinically, including clinical outcomes assessed by the visual analog score (VAS), patient satisfaction rates assessed by the North American Spine Society patient satisfaction index (PSI), recurrent rate, and residual symptoms. A total of 113 patients with PELD in our department were included in the current study, with 65 patients in the PETD group and 48 in the PEID group. Demographic characteristics including age, gender, height, BMI, cigarette smoking, alcohol consumption status, and diabetes did not show any significant difference between the PETD and PEID groups. The VAS scores of the two groups were similar preoperatively, but the postoperative VAS score of the PEID group was lower than that of the PETD group. There were 90.8% of patients in the PETD group who were satisfied with the operation compared to 97.9% in the PEID group. The recurrence rate did not differ between groups, with three patients in both groups. Regarding residual symptoms, there were more patients in the PETD group who reported low back pain during the follow-up periods. The main limitations are that all patients were operated by the same surgical team from the same site, and there was a lack of multicenter data. Both PETD and PEID have satisfactory patient-reported outcomes for treating LDH. The PEID procedure results in fewer low back pain residual symptoms than the PELD procedure.

Indirect Puncture Using a Novel Arc Puncture-Guided Device in Percutaneous Transforaminal Puncture on Goat Lumbar Spine Specimens

To investigate the implication of indirect puncture using a novel arc puncture-guided device in percutaneous transforaminal puncture in improving the puncture accuracy, reducing fluoroscopy times, puncture times and operation time. We have designed a novel arc puncture-guided device which consists of a 90°arc block and a 30°arc block. Punctures were performed on 8 fresh goat lumbar spine specimens. A senior doctor performed indirect punctures on the left side of L2/L3, L3/L4 and L4/L5 level side using the novel device (group A)，and on the right side of L2/L3, L3/L4 and L4/L5 level with conventional method (group B). We recorded the fluoroscopy times, puncture times and operation time. In group A, the first puncture could successfully reach the target after 1-3 punctures, and the one-time success rate of the second needle puncture is 91.67%. The total fluoroscopy times were 14.88±0.99 in group A and 16.08±2.22 in group B (p=0.027). The puncture times were 3.00±0.66 in group A and 6.04±2.13 in group B (P < 0.01). The operation time(s) was 273.75±30.19 in group A and 361.25±69.57 in group B (P < 0.01). There were significant differences in fluoroscopy times，puncture times and operation time between the two groups(P < 0.05). The indirect puncture using the novel arc puncture-guided device in percutaneous transforaminal puncture can significantly improve the puncture accuracy, reduce fluoroscopy times, puncture times and operation time. Indirect puncture using the novel device in percutaneous transforaminal endoscopic discectomy (PTED) is a potential and practical puncture method.

Comparative analysis of percutaneous endoscopic interlaminar discectomy for highly downward-migrated disc herniation

ObjectivesThis study aimed to evaluate the clinical efficacy and safety of percutaneous endoscopic interlaminar discectomy (PEID) for treating highly downward-migrated disc herniation.MethodsWe conducted a retrospective study on 39 patients with highly downward-migrated disc herniation who underwent PEID treatment between January 2015 and October 2020. The clinical outcomes, including the preoperative and postoperative visual analogue scale (VAS) for the back and leg, Oswestry Disability Index (ODI), and MacNab criteria for surgical success, were evaluated and compared to thirty-seven patients treated with posterior lumbar interbody fusion (PLIF).ResultsThe mean operation time of PEID was 93.00(77.00,110.00) min, while that of PLIF was 169.00(157.00,183.00) min. Continued improvement in both PEID and PLIF was observed in the VAS and ODI scores immediately after the surgery to the last follow‐up. The VAS and ODI scores of PEID one week after surgery were significantly different from those of PLIF. One patient with recurrent lumbar disc herniation in the same segment improved after undergoing repeat PEID, two patients had dura tears, and conservative treatment helped relieve the symptoms. The overall percentage of patients with good to excellent results of PELD according to the modified MacNab criteria was 97.43%, while that of PLIF was 94.60%.ConclusionsPEID has reliable efficacy and safety for treating highly downward-migrated disc herniation. And the long-term efficacy of PEID is comparable to PLIF. No severe complications occurred after surgery, and most patients’ symptoms were relieved.

Cost and Effectiveness of Percutaneous Endoscopic Interlaminar Discectomy versus Microscope-Assisted Tubular Discectomy for L5-S1 Lumbar Disc Herniation

To assess the cost and effectiveness of percutaneous endoscopic interlaminar discectomy (PEID) and microscope-assisted tubular discectomy (MATD) for patients with L5/S1 lumbar disc herniation (LDH). The medical and financial records of patients diagnosed with L5/S1 LDH and who underwent either PEID or MATD from April 2021 to April 2022 were retrospectively collected. Demographic and baseline information, perioperative observational index, clinical outcomes, and inpatient costs were analyzed. Sixty patients were included, with 30 patients in the PEID group and 30 patients in the MATD group. No significant difference was found in demographic and baseline information between the 2 groups (P > 0.05). The PEID group showed significantly shorter incision length, less intraoperative blood loss, shorter hospital stays, and higher intraoperative fluoroscopy frequency compared with the MATD group (P < 0.05). There were no significant differences in visual analog scale back/leg score, Oswestry Disability Index, and 36-Item Short-Form Survey score between PEID and MATD groups before the surgery and at any follow-up time points (P > 0.05). The total cost, surgery cost, and surgical instruments/materials cost were significantly higher in the PEID group compared with the MATD group (P < 0.05). In contrast, the drug and nursing costs were significantly higher in the MATD group than in the PEID group (P < 0.05). PEID and MATD provide equivalent clinical efficacy and safety in treating LDH at L5/S1 segment within a 1-year follow-up. However, PEID is less invasive and MATD is less costly. No one surgical technique is superior in all aspects and patients should make decisions according to their top concern.

Analysis of the Curative Effect of Diffusion Tensor Imaging-Guided Percutaneous Endoscopic Lumbar Discectomy

Diffusion tensor imaging (DTI), a novel method of describing nerve structure, is a special form of magnetic resonance imaging (MRI). This new imaging method can be used to locate the diseased nerve roots in lumbar disc herniation. The objective of this study is to compare patient outcomes between single-level and doublesection percutaneous endoscopic lumbar discectomy (PELD) in the treatment of lumbar intervertebral disc herniation with single nerve root compression, where single-sided PELD is guided by magnetic resonance diffusion tensor imaging (DTI). The clinical data of patients with lumbar intervertebral disc herniation with double compression of single nerve root symptoms in the Affiliated Hospital of Weifang Medical University from January 2019 to May 2021 were retrospectively summarized and divided into single-level percutaneous endoscopic discectomy (PELD) group after DTI localization and double-section PELD group. The operation time, intraoperative bleeding, VAS score and JOA score of the two groups were compared, as well as the preoperative and postoperative fractional anisotropy (FA) values in the DTI group. The operation time and intraoperative bleeding volume of patients in the DTI group were significantly lower than those in the double segment group, and there was no significant difference between VAS scores and JOA scores in the two groups. After the operation, the nerve root FA value of the responsible compression site of patients in the DTI group increased significantly, but it was still lower than the healthy symmetrical part. The single-level PELD based on DTI has achieved a similar effect to that of the doublesegment PELD in 3 months after the operation, which can improve the FA value of the lesion nerve root. Its bleeding amount is less, and the operation time is shorter, but the efficacy of this technology still requires long-term follow-up of large samples.

Asymptomatic postoperative discal pseudocyst and its spontaneous regression after percutaneous endoscopic interlaminar discectomy: a case description.

Asymptomatic postoperative discal pseudocyst and its spontaneous regression after percutaneous endoscopic interlaminar discectomy: a case description.

PROSPECTIVE RANDOMISED STUDY COMPARING ENDOSCOPIC DISCECTOMY WITH PERCUTANEOUS RADIO-FREQUENCYCOABLATION IN PATIENT WITH CONTAINED LUMBAR DISC PROLAPSE

Background: This study is to compare functional outcome in patients with radiculopathy with contained lumbar disc prolapse treated with endoscopic discectomy and percutaneous radio frequency co ablation. In this study, the radicular pain using VAS score and prospective functional results using SLR test were measured. Materials and Methods: Prospective randomised control study carried out in Department of Orthopaedics from the period Nov 2016 to Nov 2018. Source of data for study was the patients reporting to Orthopaedic OPD who fulfill the inclusion criteria. Total 30 patients were included in the study. Data was subjected to statistical analysis using Statistical package for social sciences (SPSS v 21.0, IBM). Inter group comparison (2 groups) was done using Mann Whitney U test. Intra group comparison was done using Wilcoxon Signed rank test (upto 2 observations) Friedmans (for &gt;2 observations) followed by followed by pair wise comparison using Wilcoxon Signed rank test. Results: The functional outcome in patients treated with radiofrequency coablation are better than patients treated with endoscopic discectomy. Conclusion: Both Radio-frequency co-ablation and percutaneous transforaminal endoscopic discectomy appear to be safe and effective minimally invasive day care treatment option for patients with contained lumbar disc prolapse with radiculopathy.

Clinical Outcomes of Percutaneous Endoscopic Interlaminar Discectomy Using a Laminotomy Technique With Modified Stepwise Local Anesthesia

Percutaneous endoscopic interlaminar discectomy (PEID) has been widely used in minimally invasive treatment of lumbar disc herniation (LDH) but is difficult to perform because of the narrow interlaminar window and painful for the patient. Therefore, further research is needed to find a safe and effective method to facilitate the development of PEID. Seventy-one consecutive patients with LDH who underwent PEID using a laminotomy technique with modified stepwise local anesthesia between July 2017 and June 2020. All patients were followed up for at least 6months. Preoperative patient demographics, perioperative outcomes, and clinical outcomes were recorded. Visual Analog Scale (VAS) scores, Oswestry Disability Index (ODI) scores, and Macnab criteria were used to assess clinical results. All patients underwent successful surgery under local anesthesia with no conversions to open surgery. The mean operation time was 79.56 ± 32.78minutes and the average hospital stay was 6.44 ± 2.98 nights. Before surgery, the mean VAS score was 5.66 ± 1.206 and the mean ODI score was 68.41 ± 6.634; the respective scores were decreased to 0.65 ± 0.635 and 7.06 ± 1.594 after 4weeks of follow-up (P < 0.001) and to 0.56 ± 0.691 and 7.11 ± 0.176 after 6months (P < 0.001). According to the MacNab criteria, the outcome was excellent in 60 cases and good in the remaining 11 cases. PEID via a laminotomy technique with stepwise local anesthesia is safe and effective for L4-5 and L5-S1 LDH.

S1 Transforaminal Epidural Anesthesia in Percutaneous Transforaminal Endoscopic Discectomy: A Case-Series Study.

Percutaneous transforaminal endoscopic discectomy (PTED) has become popular over the years due to its safety and low invasiveness. This surgery can be performed with different anesthesia techniques; however, the extent to which the surgeon and patient are satisfied with the analgesia is debatable. This study investigated the efficiency of the S1 transforaminal epidural block. This retrospective study was conducted on 60 patients with L4 - L5 lumbar disc herniation who underwent PTED under the S1 transforaminal epidural block. All patients had clinical symptoms associated with unilateral radiculopathy and were candidates for surgery. Percutaneous transforaminal endoscopy and S1 epidural block were performed by a surgeon for all patients. Of the 60 evaluated cases, 61.7% and 38.3% were female and male, respectively, with a mean age of 42.98 ± 10.79 years. The mean pain score before surgery was 7.83 ± 0.69, which decreased to 2.58 ± 0.65 during surgery and 0.50 ± 0.50 48 hours after surgery (P < 0.001). The mean duration of operation in these patients was 58.58 ± 16.95 minutes, and the mean onset time was 10.08 ± 3.12 minutes. Moreover, the mean bleeding was 124.17 ± 25.20 cc. The PTED with S1 epidural anesthesia is a simple, safe, and effective method that causes good analgesia during the operation and cooperates well with the surgeon in neurological monitoring due to patient consciousness.

Comparative Study Between Facet Line Approach and Posterolateral Approach in Percutaneous Endoscopic Transforaminal Discectomy in L4/L5 Disc Prolapse

Comparative Study Between Facet Line Approach and Posterolateral Approach in Percutaneous Endoscopic Transforaminal Discectomy in L4/L5 Disc Prolapse

Percutaneous hydrodiscectomy surgery effectiveness in chronic back pain (hydrodiscectomy in chronic back pain).

To investigate the pre-operative and post-operative characteristics of patients suffering from chronic back and radicular pain who had percutaneous hydrodiscectomy. Hydrodiscectomy is an advanced percutaneous discectomy technique that utilizes a concentrated, high flow water current for the cutting and simultaneous tissue aspiration of the intervertebral disc. Retrospective cohort study at a single center. We assessed the eligibility of all patients who had undergone hydrodiscectomy in the orthopedic department of our institution for four years period. Out of 40 eligible patients, a total of 22 patients consented to participate in the study. Study period from March 2017 to February 2022. Fifteen patients were males (68.2%), seven were females (31.8%). Mean age was 45.46 years. Patients had symptoms for a mean of 46.36 months prior to the procedure, and the mean extent of disc bulge was 5.2mm. 68.2% of the patients reported a reduction in or complete elimination of the back pain and the radicular lower limbs pain following hydrodiscectomy. 95.5% of the patients experienced no pre-, intra-, or post-operative complications. Results demonstrate that percutaneous hydrodiscectomy is safe and effective in patients with chronic back and radicular pain due to disc herniation.

Outpatient minimally invasive spine surgeries during the COVID-19 pandemic – A retrospective analysis of 164 consecutive cases

ObjectiveTo share our surgical experiences of minimally invasive cervical and lumbar procedures for patients who suffered from non-fatal motor vehicle accidents (MVAs) in the ambulatory surgery centers (ASCs) during the coronavirus disease 2019 (COVID-19) pandemic. MethodsAnterior cervical discectomy and fusion (ACDF), anterior lumbar interbody fusion (ALIF), minimally invasive laminotomy and discectomy (MILD), percutaneous endoscopic laser-assisted discectomy (PELD) and percutaneous kyphoplasty (PK) were performed on carefully selected patients. ResultsFrom January 2020 to December 2021, our group performed 164 cases on 153 patients involving 249 intervertebral disc (IVD) levels. Of these, 116 cases (70.73%) on 114 patients (74.51%) were cervical, 48 cases (29.27%) were lumbar (including 8 PK cases). Eight patients had both cervical and lumbar procedures in a single anesthetic session (SAS) and were discharged on the same day. One hundred and six ACDF cases (92.17%) were at the C4–C5 and C5–C6 levels, which comprised of 146 (76.04%) IVDs. Of the 40 non-PK lumbar cases, 38 (95.0%) were at L4 to S1 lumbar levels. Six of these cases (15.0%) involved 2 lumbar levels. In contrast, 6 out of 8 kyphoplasties (75.0%) involved lower thoracic/higher lumbar vertebral columns (T11 to L2) and 2 were at the lower lumbar L4 level. ConclusionsWe successfully and safely performed various cervical and lumbar spine surgeries in the ASCs amid COVID-19 pandemic and all patients achieved the same-day discharge (SDD). In the non-fatal MVAs, mid-lower cervical (C4 to C6) and lower lumbar (L4 to S1) IVDs were the most affected levels.

Nomogram for predicting the unfavourable outcomes of percutaneous endoscopic transforaminal discectomy for lumbar disc herniation: a retrospective study.

To investigate and integrate multiple independent risk factors to establish a nomogram for predicting the unfavourable outcomes of percutaneous endoscopic transforaminal discectomy (PETD) for lumbar disc herniation (LDH). From January 2018 to December 2019, a total of 425 patients with LDH undergoing PETD were included in this retrospective study. All patients were divided into the development and validation cohort at a ratio of 4:1. Univariate and multivariate logistic regression analyses were used to investigate the independent risk factors associated with the clinical outcomes of PETD for LDH in the development cohort, and a prediction model (nomogram) was established to predict the unfavourable outcomes of PETD for LDH. In the validation cohort, the nomogram was validated by the concordance index (C-index), calibration curve, and decision curve analysis (DCA). 29 of 340 patients showed unfavourable outcomes in the development cohort, and 7 of 85 patients showed unfavourable outcomes in the validation cohort. Body mass index (BMI), course of disease (COD), protrusion calcification (PC), and preoperative lumbar epidural steroid injection (LI) were independent risk factors associated with the unfavourable outcomes of PETD for LDH and were identified as predictors for the nomogram. The nomogram was validated by the validation cohort and showed high consistency (C-index = 0.674), good calibration and high clinical value. The nomogram based on patients' preoperative clinical characteristics, including BMI, COD, LI and PC, can be used to accurately predict the unfavourable outcomes of PETD for LDH.

Analysis of the Efficacy of Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation with Different Types/Grades of Modic Changes.

Percutaneous endoscopic interlaminar discectomy (PEID), one of the main techniques of spinal endoscopy, has achieved excellent results in treating lumbar disc herniation (LDH). However, its efficacy has not been systematically described in patients with LDH accompanied by Modic changes (MC). The purpose of this study was to observe the clinical efficacy of PEID treatment of LDH accompanied by MC. A total of 207 patients who underwent PEID surgery for LDH were selected. According to the existence and type of MC on preoperative lumbar magnetic resonance images (MRI), they were divided into normal group (no MC, n=117), M1 group (MC I, n=23), and M2 group (MC II, n=67). According to the severity of MC, they were divided into MA group (grade A, n=45) and MBC group (grade B and C, n=45). The visual analog scale (VAS) score, Oswestry disability index (ODI) score, Disc height index (DHI), Lumbar lordosis angle (LL) and modified Macnab criteria were used to assess clinical outcomes. Postoperative back pain and leg pain VAS scores and ODI scores were significantly improved in all groups compared with preoperative scores. Patients with MC showed a deterioration in postoperative back pain VAS scores and ODI scores as time went by, and postoperative DHI decreased significantly compared with preoperative. Postoperative LL did not change significantly in each group. There was no significant difference in complications, recurrence rate and excellent rate between the groups. Whether accompanied by MC or not, the efficacy of PEID for LDH was significant. However, postoperative back pain and functional status of patients with MC tend to deteriorate as time went by, especially those with type I or severe MC.

Local Anesthesia Versus General Anesthesia in Percutaneous Interlaminar Endoscopic Discectomy: A Meta-analysis.

The objective of this study was to systematically evaluate the safety and efficacy of local anesthesia (LA) and general anesthesia (GA) in percutaneous interlaminar endoscopic discectomy (PIED). We searched MEDLINE, EMBASE, EuropePMC, PubMed, Web of Science, Cochrane databases, and CNKI databases for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. A total of 6 articles with 549 study participants were included, with 282 patients in LA group and 267 patients in GA group. The results of the meta-analysis showed that the LA group had significantly better results in hospital stay time (mean difference [MD], -1.68; 95% CI, -3.35 to -0.01) and hospital costs (MD, -0.57, 95% CI, -1.02 to -0.12) compared with the GA group; whereas Oswestry Disability Index (MD, 0.48; 95% CI, -0.07 to 1.04), Visual Analog Scale Scores (MD, -0.05; 95% CI, -0.24 to 0.13), postoperative transient dysesthesia and weakness (odds ratio [OR], 0.83, 95% CI, 0.40 to 1.69), dura and nerve root injury (OR, 0.21, 95% CI, 0.03 to 1.25), operation time (MD, -3.51; 95% CI, -11.5 to 4.48), and willingness rate to receive the same procedure(OR, 0.12, 95% CI, 0.01 to 1.00) showed no significant differences between the 2 groups. LA can effectively relieve pain during PIED surgery and ensure the safety of operation without increasing the occurrence of postoperative complications. PIED under LA not only has similar patient satisfaction but also shows obvious advantages in shortening hospital stay and reducing hospital costs compared with GA surgery.

Angulation error assessment for the trajectory in the anteroposterior and lateral fluoroscopic views during percutaneous endoscopic transforaminal lumbar discectomy

BackgroundAnteroposterior (AP) and lateral fluoroscopies are often used to evaluate the intraoperative location and angulation of the trajectory in percutaneous endoscopic transforaminal lumbar discectomy (PETLD). Although the location of the trajectory shown in fluoroscopy is absolutely accurate, the angulation is not always reliable. This study aimed to evaluate the accuracy of the angle shown in the AP and lateral fluoroscopic views.MethodsA technical study was performed to assess the angulation errors of PETLD trajectories shown in AP and lateral fluoroscopic views. After reconstructing a lumbar CT image, a virtual trajectory was placed into the intervertebral foramen with gradient-changing coronal angulations of the cephalad angle plane (CACAP). For each angulation, virtual AP and lateral fluoroscopies were taken, and the cephalad angles (CA) of the trajectory shown in the AP and lateral fluoroscopic views, which indicated the coronal CA and the sagittal CA, respectively, were measured. The angular relationships among the real CA, CACAP, coronal CA, and sagittal CA were further demonstrated with formulae.ResultsIn PETLD, the coronal CA is approximately equal to the real CA, with a small angle difference and percentage error, whereas the sagittal CA shows a rather large angle difference and percentage error.ConclusionThe AP view is more reliable than the lateral view in determining the CA of the PETLD trajectory.

Percutaneous Transforaminal Endoscopic Discectomy Learning Curve: A CuSum Analysis.

Retrospective review of prospectively collected data. To describe the learning curve for percutaneous transforaminal endoscopic discectomy (PTED) and demonstrate its efficacy in treating lumbar disc herniation. The learning curve for PTED has not yet been standardized in the literature. Consecutive patients who underwent lumbar PTED by a single surgeon between December 2020 and 2022 were included. Cumulative sum analysis was applied to operative and fluoroscopy time to assess the learning curve. Inflection points were used to divide cases into early and late phases. The 2 phases were analyzed for differences in operative and fluoroscopy time, length of stay, complications, and patient-reported outcome measures (PROMs). Patient characteristics and operative levels were also compared. PROMs entailed the Oswestry Disability Index, Patient-Reported Outcomes Measurement Information System, Visual Analog Scale Back/Leg, and 12-item Short Form Survey at preoperative, early postoperative (<6mo), and late postoperative (≥6mo) time points. PROMs between PTED cases and a comparable cohort of tubular microdiscectomy cases, performed by the same surgeon, were compared. Fifty-five patients were included. Cumulative sum analysis indicated that both operative and fluoroscopy time diminished rapidly after case 31, suggesting a learning curve of 31 cases (early phase: n = 31; late phase: n = 24). Late-phase cases exhibited significantly lower operative times (85.7 vs . 62.2min, P = 0.001) and fluoroscopy times (131.0 vs . 97.2 s, P = 0.001) compared with the early-phase cases. Both early and late-phase cases showed significant improvement in all PROMs. There were no differences in PROMs between the patients who underwent PTED and tubular microdiscectomy. The PTED learning curve was found to be 31 cases and did not impact PROMs or complication rates. Although this learning curve reflects the experiences of a single surgeon and may not be broadly applicable, PTED can serve as an effective modality for the treatment of lumbar disc herniation.

The safety and efficacy of percutaneous transforaminal endoscopic discectomy and fenestration discectomy in the treatment of lumbar disc herniation.

The aim of the study was to explore the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and fenestration discectomy (FD) in the treatment of lumbar disc herniation (LDH). The complete clinical data from 87 patients with LDH from our hospital were retrospectively analyzed. Patients were divided into a control group (n = 39, treated with FD) and a research group (n = 48, treated with PTED) according to the prescribed treatments. The basic operation conditions were compared across the two groups. Surgical outcomes were assessed. The incidences of complications and the life quality of patients were evaluated 1 year after surgery. The patients in both groups completed the operation. The visual analog scale and Oswestry Disability Index score of patients in the research group was significantly lower while the Orthopaedic Association Score was significantly higher after surgery. The success rate of the operation in the research group which was significantly higher and the rate of complications was significantly lower. No statistical differences in the quality of life were observed between the patients (p > 0.05). PTED and FD are effective in the treatment of LDH. However, our study showed that PTED has a higher rate of treatment success, faster recovery times and is safer than FD.