Percutaneous Endoscopic Lumbar Discectomy Technique Research Articles

Retrospective Analysis of Paraspinal Muscle-Splitting Microscopic-Assisted Discectomy Versus Percutaneous Endoscopic Lumbar Discectomy for the Treatment of Far-Lateral Lumbar Disc Herniation.

To compare percutaneous endoscopic lumbar discectomy (PELD) and the microscopic tubular technique, and to evaluate the outcomes of surgery. We collected information through retrospective analysis of patients with far-lateral lumbar disc herniation (FLLDH) from June 2015 to October 2018. Twenty-six patients underwent paraspinal muscle-splitting microscopicassisted discectomy (MD) and thirty patients underwent PELD surgery by the same surgical team. Data included the duration of the operation, duration of intraoperative radiation exposure, and average duration of hospitalization. Pre- and postoperative pain scores and neurological functions were recorded using the visual analog scale (VAS) score and Oswestry disability index (ODI). Fifty-six patients remained in the study over the 12-24 months period. The mean operating time was 65.83 ± 16.64 min in the PELD group, mean duration of radiation exposure was 154.98 ± 64.26 mGy, and average of hospitalization was 3.43 days. The mean operating time was 44.96 ± 16.87 min in the MD group, duration of radiation exposure was 42.12 ± 17.28 mGy, and duration of hospitalization was 4.12 days. There were two patients with postoperative transient dysesthesia and one underwent reoperation seven months after surgery in the PELD group. One patient had postoperative transient dysesthesia in the MD group. Except low back pain at three months (p > 0.05), all patients in both groups showed significant improvement in VAS and ODI scores compared with pre-operation and until final follow-up (p < 0.05). Both techniques are minimally invasive, effective, and safe for treating FLLDH in selected patients. Compared with the PELD technique, the MD procedure offers a wider field of vision during operation, shorter operation time, fewer postoperative complications, and shorter learning curve.

Initial Experience and Analysis of Outcomes Using the Visualized Percutaneous Endoscopic Lumbar Discectomy Technique for the Treatment of Lumbar Disc Herniation.

To introduce a visual surgical concept using a retrospective comparison of the outcomes between visualized percutaneous endoscopic lumbar discectomy (V-PELD) and conventional PELD techniques. Data from 61 patients in the conventional PELD group and 55 in the V-PELD group. Data included the duration of the operation, number of intraoperative radiation exposure events, and follow-up information for 24 months. The Oswestry Disability Index (ODI) and visual analog scale (VAS) scores were collected. The mean (± SD) operating time for the V-PELD group was 57.82 ± 11.25 min, and the mean duration of radiation exposure was 0.74 ± 0.32 min. The mean operating time for the conventional group was 63.16 ± 14.49 min (p < 0.05), and the mean duration of radiation exposure was 2.81 ± 1.12 min (p < 0.001). All patients in both groups demonstrated significant improvement in the ODI and VAS scores after surgery (p < 0.05). V-PELD is a minimally invasive surgical technique that involves less radiation exposure and is more efficient for treating lumbar disc herniation.

Percutaneous endoscopic lumbar discectomy: minimally invasive technique for multiple episodes of lumbar disc herniation

BackgroundsAlthough open lumbar discectomy is a gold standard surgical technique for lumbar disc herniation (LDH), surgery-induced tissue injury may actually become a source of postsurgical pain. Percutaneous endoscopic lumbar discectomy (PELD) is introduced as a minimal invasive spinal technique for LDH. The PELD has gained popularity and shown successful results. The authors report the clinical usefulness of the PELD technique in two patients with the serial multilevel LDHs.Case presentationsA 32-year-old man suffered from radicular pain at the L5 dermatome due to the down migrated soft LDH at the L4–5 level. The PELD was performed to remove the ruptured fragments, yielding a complete decompression of the L5 nerve root. Four years later, he visited the clinic because of right leg radiating pain along the S1 dermatome. An MRI scan revealed the LDH at the L5-S1 level. The PELD with foraminoplasty was also performed successfully at the L5-S1 level. Two months after the second PELD, he visited the clinic again because of severe pain along the left L4 dermatome; consequently, the PELD was also performed at the L3–4 level without any complications. A 34-year-old man presented with radiating pain in the back and both legs at the L5 dermatome. The MR images show a disc extrusion at the L4–5. The patient underwent the PELD at the L4–5 via the left approach. After the PELD, the back and leg pain both improved. One year later, the patient suffered from severe pain in the back and the left anterior thigh. The MR images show a left paramedian LDH at the L2–3. After the PELD was performed at the L2–3, the pain was relieved. The final MR images show no signs of any aggravated degeneration of the intervertebral discs or the facet joints at all of the treated levels.ConclusionWhen multiple episodes of LDH occur in a patient’s life span, PELD could be considered as an alternative good technique to treat LDH in each step by preserving normal anatomic structures.

Risk factors for failure of single-level percutaneous endoscopic lumbar discectomy

Few studies have addressed surgical failures and complications following percutaneous endoscopic lumbar discectomy (PELD), and no previous study has investigated the risk factors that lead to surgical failure. The authors report their experience using PELD for single-level lumbar disc herniation (LDH) to provide insights into the rates of surgical failure and identify potential risk factors that lead to this complication. The authors retrospectively reviewed the medical records of 350 patients who underwent PELD for single-level LDH and identified 36 patients (10.3%) who underwent reoperation due to the failure of PELD. Patients' mean visual analog scale of pain scores and Oswestry Disability Index scores improved significantly from 6.6 ± 2.1 and 51.6 ± 19.4 preoperatively to 1.9 ± 1.4 and 28.3 ± 12.0, respectively, at 1 month postoperatively and 1.2 ± 1.1 and 9.3 ± 7.8, respectively, at 1 year postoperatively. The frequencies with which patients took analgesic medications significantly decreased from 74.6% preoperatively to 19.7% at 1 month postoperatively and 10.0% at 1 year postoperatively. Relatively older patients (p = 0.005) and those ≥ 60 years old (p = 0.001) experienced larger numbers of failures compared to younger patients. An analysis of potentially contributing comorbid conditions indicated that significantly more patients with diabetes were present in the PELD failure group (p = 0.017). As surgeons gained familiarity with the procedure, outcomes improved. The failure rate during the authors' early use of the PELD technique (Cases 1-70) was 17.1%; the failure rate then fell to 5.7% (p = 0.034) (Cases 141-210) before finally stabilizing at 10.0% (Cases 211-280 and Cases 281-350). The surgical failure rate following PELD for LDH was 10.3%. Older patients, elderly patients (age ≥ 60 years), and patients with diabetes were at increased risk of surgical failure of PELD, particularly in the early years of the procedure's use.