Percutaneous Endoscopic Interlaminar Discectomy Research Articles

Unilateral Biportal Endoscopic Discectomy versus Percutaneous Endoscopic Interlaminar Discectomy for Lumbar Disc Herniation.

As the latest endoscopic spine surgery, percutaneous endoscopic interlaminar discectomy (PEID) and unilateral biportal endoscopic (UBE) discectomy have distinct technical characteristics. This study aimed to evaluate the clinical outcomes of PEID and UBE discectomy in the treatment of single-level lumbar disc herniation (LDH). Between February 2019 and April 2022, 115 patients with single-level LDH at L4-5 or L5-S1 received PEID or UBE discectomy. The patients were separated into two groups based on the surgical method used: Group 1 (the PEID group) (n = 60) and Group 2 (the UBE group) (n = 55). Various parameters, including operative time, hospitalization time, fluoroscopy frequency, total costs, complications, visual analogue scale (VAS), and Oswestry Disability Index (ODI), were evaluated and compared between the two groups. There were no significant differences in the VAS and ODI scores in 12 months after the operation between two groups (P > 0.05). However, the VAS of lower back pain on the first day after the operation in Group 2 (2.53±0.89) was higher than that in Group 1 (2.19±0.74) (P < 0.05). There were no significant differences in the operation time and incidence of complications between two groups (P > 0.05). But total costs in Group 2 (43,121±4280) were significantly higher than those in Group 1 (30,069±3551) (P < 0.05). Both UBE and PEID procedures have similar efficacy in alleviating pain and improving functional ability in patients with LDH. However, UBE surgery results in higher costs than PEID surgery.

Modified Percutaneous Endoscopic Interlaminar Discectomy through the Near-spinous Process Approach for L4/5 Disc Herniation: A Retrospective Clinical Study.

Compared with traditional open surgery, percutaneous endoscopic lumbar discectomy (PELD) has the advantages of less trauma, faster recovery, and less postoperative pain, so it has been widely used in the field of spinal surgery. However, it still has the defect of intraoperative fluoroscopy occurrences, complications, and even the risk of damage to the spinal cord and nerve. This study aims to compare the clinical efficacy of modified percutaneous endoscopic interlaminar discectomy (MPEID) with percutaneous endoscopic transforaminal discectomy (PETD) in treating L4/5 lumbar disc herniation (LDH) and to evaluate the effectiveness and safety of MPEID. Thirty-four L4/5 LDH patients treated at the Second Affiliated Hospital of Nanchang University from June 2020 to June 2021 were studied retrospectively. Seventeen underwent MPEID and seventeen PETD. Variables analyzed included demographics, operative duration, intraoperative fluoroscopy occurrences, and surgical outcomes. Effectiveness was evaluated using the visual analogue scale (VAS), Oswestry disability index (ODI), and modified MacNab criteria. Lumbar Magnetic Resonance Imaging (MRI) was used to assess radiological outcomes. A paired t-test was performed to compare intragroup pre- and postoperative clinical data, VAS, and ODI scores. The average operative time in PETD group was 91.65 ± 14.04 min, and the average operative time in MPEID group was 65.41 ± 12.61 min (p < 0.001). In PETD group, the fluoroscopy occurrences averaged 9.71 ± 1.05 times, with fluoroscopy occurrences averaging 6.47 ± 1.00 times (p < 0.001) in MPEID group. At 12 months follow-up, the clinical effect showed significant improvement in both two groups. The MPEID group showed a decrease in average VAS-back score from 5.41 ± 2.18 to 1.76 ± 1.09 (p < 0.001) and VAS-leg score from 6.53 ± 1.66 to 0.82 ± 0.64 (p < 0.001). The ODI scores decreased from 51.35 ± 10.65 to 11.71 ± 2.91 (p < 0.001). In the PETD group, the VAS-back score decreased from 4.94 ± 1.98 to 2.06 ± 1.25 (p < 0.001), VAS-leg score from 7.12 ± 1.73 to 1.12 ± 0.60 (p < 0.001), and ODI scores from 48.00 ± 11.62 to 12.24 ± 2.56 (p < 0.001). According to the modified MacNab criteria, MPEID had 15 excellent and two good results; PETD had 12 excellent and 5 good (p = 0.23). No nerve root injuries, dural tears, or significant complications were reported. MPEID and PETD effectively treat L4/5 LDH, with MPEID showing shorter operative times and fewer fluoroscopies. Furthermore, the MPEID group can provide excellent clinical efficacy as the PETD group in the short term.

Effect and complication among different kinds of spinal endoscopic surgery for lumbar disc herniation

To compare clinical efficacy and complication rate of percutaneous endoscopic transforaminal discectomy(PETD),percutaneous endoscopic interlaminar discectomy (PEID) and unilateral biportal endoscopic (UBE) in treating single-segment lumbar disc herniation(LDH). From October 2019 to August 2021,121 LDH patients with single-segment treated by spinal endoscopy were retrospectively analyzed and divided into three groups. In PETD group,there were 48 patients,including 19 males and 29 females,aged from 18 to 72 years old with an average of (44.0±13.9) years old;3 patients with L3,4 segments,27 patients with L4,5 segments,and 18 patients with L5S1 segments. In PEID group,there were 43 patients,including 23 males and 20 females,aged from 20 to 69 years old with an average of (40.1±12.1) years old;1 patient with L3,4 segments,15 patients with L4,5 segments,and 27 patients with L5S1 segments. In UBE group,there were 30 patients,including 12 males and 18 females,aged from 29 to 72 years old with an average of (41.2±15.0) years old;1 patient with L3,4 segments,18 patients with L4,5 segments,and 11 patients with L5S1 segments. Operation time,blood loss,fluoroscopy times and complications among three groups were observed and compared. Before opertaion,3 months after operation and at the latest follow-up,visual analogue scale (VAS) was used to evaluate low back pain and lower extremity pain,Oswestry disfunction index (ODI) was used to evaluate lumbar function,and modified MacNab was used to evaluate clinical efficacy at the latest follow-up. All patients were performed endoscopic spinal surgery completly and were followed up for at least 12 months. One patient occurred dural sac rupture both in PETD and PEID group,and dural sac rupture was small,and there was no obvious discomfort after operation. Two patients were occurred intraoperative rupture of dural sac in UBE group. One patient was occurred cerebrospinal fluid leakage after operation,and was improved after rest in supine position and fluid rehydration. One patient without no significant postoperative discomfort. (1)There were no significant difference in operating time,blood loss and hospital stay between PETD and PEID group (P>0.05),while UBE group was higher than those of PETD and PEID group (P<0.05). There was no statistical significance in fluoroscopy times between PEID and UBE group (P>0.05),but PETD group was higher than that of PEID and UBE group (P<0.05). (2)VAS of low back pain at 3 months after operation in UBE group was higher than that in PETD and PEID group (P<0.05),but there was no significant difference between PETD and PEID group (P>0.05). At the latest follow-up,there was no significant difference in VAS of low back pain among three groups (P>0.05). (3)Lower extremity pain of VAS and ODI among 3 groups after operation were significantly improved at all time points compared with those before opertaion(P<0.05),and there were no statistical significance between groups (P>0.05),and there were no statistical significance in interaction between different time points and operation groups (P>0.05). (4) At the latest follow-up,according to the modified MacNab standard,the results of PETD group were excellent in 27 patients,good in 16 patients,moderate in 4 patients,poor in 1 patient;in PEID group,27 patients got excellent result,12 good,3 moderate,and 1 poor;in UBE group,16 patients got excellent,10 good,2 moderate,and 2 poor. There was no significant difference among three groups (χ2=0.308,P>0.05). Recurrence of lumbar disc herniation occurred in 1 patient among each three groups,symptoms were improved in 2 patients after symptomatic treatment,and 1 patient was treated in other hospitals. PETD,PEID and UBE techniques could achieve good early clinical effects in treating lumbar disc herniation with similar complication rates. Both of PETD and PEID are single-channel minimally invasive surgery,with mild intraoperative tissue damage and quick postoperative recovery; while intraoperative fluoroscopy of PETD was relatively more frequent, and PEID was more suitable for L5S1 segment;UBE is a two-channel surgery,in which the intraoperative soft tissue damage is more severe,but exposure is broad,which is more suitable for complex cases.

Predicting and analysing of the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation: development and validation based nomogram.

To predict and analyse the unfavourable outcomes of early applicated percutaneous endoscopic interlaminar discectomy for lumbar disc herniation. Information of 426 patients treated by early applicated percutaneous endoscopic interlaminar discectomy (PEID) for lumbar disc herniation (LDH) at our hospital from June 2017 to October 2021 in addition to 17 other features was collected. The risk factors were selected by the least absolute shrinkage and selection operator method (LASSO) regression. Then, a prediction model (nomogram) was established to predict the unfavourable outcomes of using the risk factors selected from LASSO regression. Bootstrap (n = 1000) was used to perform the internal validation, and the performance of the model was assessed by the concordance index (C-index), receiver operating characteristic curve, and calibration curve. The decision curve analysis (DCA) and clinical impact curve (CIC) were used to assess the clinical utility of the model, respectively. Finally, 53 of 426 patients showed unfavourable outcomes. Five potential factors, Modic change, Calcification, Lumbar epidural steroid injection preoperative, Articular process hyperplasia and cohesion, and Laminoplasty technique, were selected according to the LASSO regression, that identified the predictors to establish nomogram model. Meanwhile, the C-index of the prediction nomogram was 0.847, the area under the receiver operating characteristic curve value was 0.847, and the interval bootstrapping (n = 1000) validation C-index was 0.809. The model has good practicability for clinics according to the DCA and CIC. This nomogram model has good predictive performance and clinical practicability, which could provide a certain basis for predicting unfavourable outcomes of early applicated PEID for LDH.

Treatment of L5-S1 Floating Calcified Lumbar Disc Herniation with Percutaneous Endoscopic Interlaminar Discectomy.

The floating calcified tissue in floating calcified lumbar disc herniation (FCLDH) is hard and often adheres to the dura mater, which can easily cause nerve root damage during surgery, making the operation challenging. We proposed the classification of FCLDH and a new technique for removing floating calcified tissue and reported the clinical efficacy and safety of this new technique in clinical practice. From January 2019 to October 2021, 24 patients (13 males and 11 females, 46.4 ± 7.72 years) with L5-S1 floating calcified lumbar disc herniation were treated with percutaneous endoscopic interlaminar discectomy (PEID). According to FCLDH classification, a total of Type Ia: nine cases, Type Ib: five cases, Type IIa: four cases, and Type IIa: six cases were included. The visual analogue scale (VAS) and Oswestry disability index (ODI) were recorded pre-operatively and 3 days postoperatively, 6 months postoperatively, and at the last follow-up. The postoperative curative effect was evaluated according to the modified MacNab criteria. Computed tomography (CT) and magnetic resonance imaging (MRI) of the lumbar spine were performed 3 days after surgery to evaluate the efficacy of the surgery. All patients successfully underwent PEID. The VAS and ODI scores at 3 days postoperatively, 6 months postoperatively, and at the last follow-up were significantly improved and statistically significant compared to those of the preoperative period (p < 0.05). All the patients were followed up for 12-24 months (mean, 16.6 ± 4.6 months). At the last follow-up, according to the modified MacNab criteria, 15 cases were excellent, eight were good, and one was fair. The combined excellent and good rate was 95.83% (23/24). Postoperative review revealed that all floating calcified tissues were effectively removed and the nerve roots were adequately decompressed without complications such as cerebrospinal fluid leakage and lumbar spine infection. The classification of FCLDH we proposed can well guide the selection of surgical plans. PEID combined with floating calcified tissue removal technology has good efficacy in the treatment of L5-S1 FCLDH, ensuring accurate removal of calcified tissue, reducing complications and improving the quality of life of affected individuals.

Endoscopic Revision Strategies and Outcomes for Recurrent L4/5 Disc Herniation After Percutaneous Endoscopic Transforaminal Discectomy.

We explore the endoscopic revision and surgical techniques for L4/5 recurrent disc herniation (rLDH) after percutaneous endoscopic transforaminal discectomy (PETD). A retrospective study was conducted. From January 2016 to September 2022, 96 patients who underwent percutaneous endoscopic lumbar discectomy for L4/5 rLDH after PETD were enrolled in the study. Based on the revision approach, the patients were divided into PETD group (57 cases) and percutaneous endoscopic interlaminar discectomy (PEID) group (39 cases). Visual Analogue Scale (VAS) for back and leg pain, Oswestry Disability Index (ODI), and modified MacNab standard were recorded to evaluate the clinical outcomes. No significant differences were found in the demographic data and intraoperative blood loss between the two groups (P>0.05), but the time of operation and intraoperative X-ray fluoroscopy exposures in the PEID group were significantly less than that in the PETD group (P<0.05). The patients' postoperative clinical indexes gradually improved, and the VAS score, ODI index, and JOA score of the patients in both groups showed significant improvement compared with the preoperative period at the 1-week, 1-month, and 6-month postoperative follow-ups (P < 0.05). There was no serious complication observed during the follow-up. For recurrent LDH after PETD of L4/5 segments, percutaneous endoscopic revision can achieve satisfactory results. Among them, PEID has a shorter operative and fluoroscopy time and allows avoidance of the scar that forms after the initial surgery, so it can be considered preferred when both procedures can remove the disk well. However, for some specific types of herniation, a detailed surgical strategy is required.

Hidden blood loss in three different endoscopic spinal procedures for lumbar disc herniation

Purpose: This study compared hidden blood loss (HBL) among three different endoscopic spinal procedures and investigated its risk factors. Patients and methods: This single-centre retrospective analysis collected data from consecutive hospitalized patients with single-segment lumbar disc herniation (LDH) undergoing unilateral biportal endoscopic discectomy (UBE), percutaneous endoscopic transforaminal discectomy (PETD), or percutaneous endoscopic interlaminar discectomy (PEID) from December 2020 to October 2022. HBL was calculated using Nadler’s and Gross’s formulas. The authors used Pearson’s or Spearman’s correlation analysis to explore the relationship between patient characteristics and HBL. Multivariate linear regression analysis was used to identify independent risk factors for HBL. Results: In total, 122 consecutive patients (68 females and 54 males) were enroled in this study. The average HBL was 381.87±218.01 ml in the UBE group, 252.05±118.44 ml in the PETD group and 229.63±143.9 ml in the PEID group (P&lt;0.05). Pearson’s or Spearman’s correlation analysis showed that operative time, preoperative haemoglobin, preoperative haematocrit, and preoperative Albumin (ALB) were correlated with HBL in the UBE group, while sex, age, operative time, postoperative ALB, and patients’ blood volume (PBV) were related to HBL in the PETD group (P&lt;0.05). Operative time and preoperative activated partial thromboplastin time were related to HBL in the PEID group (P&lt;0.05). Multiple linear regression analysis showed a positive correlation between HBL and operative time in all three groups (P&lt;0.001, P&lt;0.001, P&lt;0.05). Conclusion: HBL was higher in the UBE group than in the PETD and PEID groups, and operative time may be a common risk factor for the three groups.

Percutaneous endoscopic transforaminal vs. interlaminar discectomy for L5–S1 lumbar disc herniation: a retrospective propensity score matching study

ObjectivePercutaneous endoscopic lumbar discectomy (PELD) is a safe and effective minimally invasive surgery for treating lumbar disc herniation (LDH); however, the comparative clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in treating L5–S1 LDH remains unclear. This study compared the clinical advantages of PEID and PETD for treating L5–S1 LDH.MethodsThis was a single-centre retrospective study analysing clinical data from 120 patients with L5–S1 LDH between February 2016 and May 2020. Propensity score matching (PSM) was used to adjust for imbalanced confounding variables between the two groups. Perioperative data were recorded, and clinical outcomes, including functional scores and imaging data, were compared between groups. Functional scores included visual analogue scale (VAS) for back and leg pain, Oswestry disability index (ODI), and modified MacNab criteria. Imaging data included disc height index (DHI), ratio of greyscale (RVG), and range of motion (ROM) of the responsible segment.ResultsAfter PSM, 78 patients were included in the study, and all covariates were well balanced between the two groups. In the matched patients, the PEID group showed significantly shorter surgical time (65.41 ± 5.05 vs. 84.08 ± 5.12 min) and lower frequency of fluoroscopy (2.93 ± 0.63 vs. 11.56 ± 1.54) compared with the PETD group (P < 0.001). There were no statistically significant differences in intraoperative blood loss, postoperative hospital stay, total incision length, and incidence of complications between the two groups (P > 0.05). After surgery, both groups showed significant improvement in back and leg pain based on VAS and ODI scores (P < 0.05). There were no statistically significant differences in clinical functional scores and imaging data between the two groups at various time points after surgery (P > 0.05). According to the modified MacNab criteria, the excellent and good rates in the PEID group and PETD group were 91.89% and 89.19%, respectively, with no statistically significant difference (P > 0.05).ConclusionPEID and PETD have similar clinical efficacy in treating L5–S1 disc herniation. However, PEID is superior to PETD in reducing operation time and frequency of fluoroscopy.

Stability simulation analysis of targeted puncture in L4/5 intervertebral space for PELD surgery.

Introduction: The application prospects of percutaneous endoscopic lumbar discectomy (PELD) as a minimally invasive spinal surgery method in the treatment of lumbar disc herniation are extensive. This study aims to find the optimal entry angle for the trephine at the L4/5 intervertebral space, which causes less lumbar damage and has greater postoperative stability. To achieve this, we conduct a three-dimensional simulated analysis of the degree of damage caused by targeted puncture-based trephine osteotomy on the lumbar spine. Methods: We gathered clinical CT data from patients to construct a lumbar model. This model was used to simulate and analyze the variations in trephine osteotomy volume resulting from targeted punctures at the L4/5 interspace. Furthermore, according to these variations in osteotomy volume, we created Finite Element Analysis (FEA) models specifically for the trephine osteotomy procedure. We then applied mechanical loads to conduct range of motion and von Mises stress analyses on the lumbar motion unit. Results: In percutaneous endoscopic interlaminar discectomy, the smallest osteotomy volume occurred with a 20° entry angle, close to the base of the spinous process. The volume increased at 30° and reached its largest at 40°. In percutaneous transforaminal endoscopic discectomy, the largest osteotomy volume was observed with a 50° entry angle, passing through the facet joints, with smaller volumes at 60° and the smallest at 70°. In FEA, M6 exhibited the most notable biomechanical decline, particularly during posterior extension and right rotation. M2 and M3 showed significant differences primarily in rotation, whereas the differences between M3 and M4 were most evident in posterior extension and right rotation. M5 displayed their highest stress levels primarily in posterior extension, with significant variations observed in right rotation alongside M4. Conclusion: The appropriate selection of entry sites can reduce lumbar damage and increase stability. We suggest employing targeted punctures at a 30° angle for PEID and at a 60° angle for PTED at the L4/5 intervertebral space. Additionally, reducing the degree of facet joint damage is crucial to enhance postoperative stability in lumbar vertebral motion units.

Comparison of clinical outcomes between unilateral biportal endoscopic discectomy and percutaneous endoscopic interlaminar discectomy for migrated lumbar disc herniation at lower lumbar spine: a retrospective controlled study

BackgroundBoth Unilateral Biportal Endoscopic Discectomy (UBED) and Percutaneous Endoscopic Interlaminar Discectomy (PEID) have resulted in favorable clinical outcomes in the management of LDH. The aim of this study is to comprehensively compare the efficacy of UBED and PEID in treating migrated LDH in the lower lumbar spine, with a specific focus on high-grade migrated LDH.Methods96 patients who underwent UBED (31 cases) and PEID (65 cases) procedures were enrolled in the study. All patients received a minimum follow-up period of 6 months. Clinical outcomes of the patients were assessed with incision length, operation time, total hemoglobin loss, hospital stay, intraoperative fluoroscopy times, visual analogue scale (VAS) for lower back and leg pain, Oswestry disability index (ODI), modified MacNab criteria, complications, area of lamina loss and increased intervertebral height.ResultsThe VAS scores for lower back and leg pain and ODI significantly decreased in both groups after the operation. Preoperatively, at 1 day, 1 month, and 6 months after the procedure, the VAS and ODI scores exhibited no significant differences between the two groups. There was no significant difference in terms of modified MacNab criteria, area of lamina loss, and increased intervertebral height. The UBED group had a longer incision length, operation time and postoperative hospital stay, and fewer intraoperative fluoroscopy times than to the PEID group. Complications were noted in both groups throughout the follow-up period, but there was no significant difference in the rate of complications. Moreover, there were no notable differences in clinical outcomes between the two groups in the high-grade migrated LDH.ConclusionsBoth UBED and PEID could achieve favorable clinical outcomes for treating migrated LDH at the lower lumbar spine. Despite the longer operative time and postoperative hospital stay associated with the UBED group, UBED remains safe and innovative for treating migrated LDH at the lower lumbar spine.

Comparison of percutaneous endoscopic interlaminar discectomy and conventional open lumbar discectomy for L4/5 and L5/S1 double-segmental lumbar disk herniation

ObjectiveAlthough spinal endoscopic techniques have shown great advantages in the treatment of single-segment lumbar disk herniation (LDH), the therapeutic advantages for double-segment LDH are controversial. To compare the outcomes of percutaneous endoscopic interlaminar discectomy (PEID) versus conventional open lumbar discectomy (COLD) for the treatment of L4/5 and L5/S1 double-segmental LDH.MethodsFrom January 2016 to September 2021, we included 50 patients with double-segmental LDH who underwent PEID (n = 25) or COLD (n = 25). The clinical outcomes between the two groups were evaluated using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified MacNab criteria. Moreover, the incision length, operation time, intraoperative fluoroscopy time, postoperative bedtime, hospital stays, and complications were also recorded and compared after surgery.ResultsIn both groups, the VAS and ODI scores at different timepoints postoperatively were significantly improved compared with those preoperatively (P < 0.05) According to the modified MacNab criteria, the excellent or good outcome rate was 92% in the PEID group and 88% in the COLD group. The PEID group had shorter incision length, postoperative bedtime, and hospital stays than the COLD group. However, the operation time was shorter and intraoperative fluoroscopy time was fewer in the COLD group. In addition, there was no significant difference between the two groups in terms of surgical complications during the postoperative follow-up period.ConclusionsBoth PEID and COLD have good efficacy and high safety for management of L4/5 and L5/S1 double-segmental LDH. Compared with the COLD group, the PEID group had more operative time as well as more intraoperative fluoroscopy, but it had a more minimally invasive surgical incision as well as faster postoperative recovery.

Radiographic characteristics-based classification system for percutaneous endoscopic lumbar discectomy surgical approach selection in patients with L5-S1 disc herniation: a hierarchical clustering analysis.

No classification system exists for aiding the selection of surgical approaches in L5-S1 disc herniation when undergoing percutaneous endoscopic lumbar discectomy (PELD). We aimed to identify radiographic subtypes to aid the selection of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) in patients with L5-S1 disc herniation via unsupervised hierarchical clustering analysis. In this retrospective case-control study, we gathered 296 anteroposterior and lateral lumbar spine radiographs (dataset 1) from Tianjin Hospital between January 2016 and October 2021 for clustering analyses. Additionally, we analyzed 111 patients who underwent PEID or PETD for L5-S1 disc herniation at Tianjin Hospital from January 2016 to August 2022. We included patients with radicular leg pain or back pain associated with intra-canal disc herniation who failed in conservative treatments over 6 weeks. First, pair-wise Spearman correlation coefficients were calculated among plain radiographic metrics in dataset 1 to reveal the association among these radiographic metrics. Second, hierarchical clustering analysis was conducted to unsupervised cluster the plain films into several subtypes. Last, for each radiographic subtype, the intraoperative blood loss (IBL), operation time (OT), total operating room time (TORT) along with visual analogue scale (VAS) and Oswestry Disability Index (ODI) were compared between patients underwent PETD or PEID with age as covariates. This study yielded 3 main findings: (I) iliac height (IH) was negatively correlated with intervertebral foramen width (IFW), intervertebral foramen height (IFH), and intertransverse height (ITH) (R=-0.50, -0.42, and -0.46, all P<0.001), ITH was positively correlated with IFW and IFH (R=0.40 and 0.53, all P<0.001); (II) 2 lumbosacral radiographic subtypes were identified via hierarchical clustering analysis; (III) relative to subtype 1, the patients identified as subtype 2 exhibited lesser IBL, shorter OT, and shorter TORT following PETD (t=2.92, P=0.006; t=2.65, P=0.012; t=3.17, P=0.003). The morphology pattern of the lumbosacral region affect the ease of different PELD procedures when performing percutaneous discectomy at the segment of L5-S1. Without considering the type of disc herniation, this classification system might aid spine surgeons in the selection of an appropriate surgical approach.

In Reply to the Letter to the Editor Regarding “Cost and Effectiveness of Percutaneous Endoscopic Interlaminar Discectomy versus Microscope-Assisted Tubular Discectomy for L5-S1 Lumbar Disc Herniation”

In Reply to the Letter to the Editor Regarding “Cost and Effectiveness of Percutaneous Endoscopic Interlaminar Discectomy versus Microscope-Assisted Tubular Discectomy for L5-S1 Lumbar Disc Herniation”

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.

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.

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.

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.

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.

Complications and Management of Endoscopic Spinal Surgery.

In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as "endoscopic spinal surgery," "endoscopic cervical foramoinotomy," "PECD," "percutaneous transforaminal discectomy," "percutaneous endoscopic interlaminar discectomy," "PELD," "PETD," "PEID," "YESS" and "TESSYS." We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation.