Percutaneous Transforaminal Endoscopic Discectomy Research Articles

Feasibility of Virtual Reality Combined with Isocentric Navigation in Transforaminal Percutaneous Endoscopic Discectomy: A Cadaver Study.

ObjectivesTransforaminal percutaneous endoscopic discectomy (TPED) is one of the most commonly used minimally invasive spine surgeries around the world. However, conventional surgical planning and intraoperative procedures for TPED have relied on surgeons’ experience, which limits its standardization and popularization. Virtual reality (VR) is a novel technology for pre‐surgical planning in various fields of medicine, while isocentric navigation can guide intraoperative procedures for TPED. The present study aimed to explore the feasibility of applying VR combined with isocentric navigation in TPED on cadavers.MethodsThe surgical levels were L3/L4 and L4/L5 as well as L5/S1 of both sides of each cadaver specimen. First, the surgeon manually conducted the above procedures on the left side of every specimen without preoperative simulation and isocentric navigation (Group A). Then the same surgeon conducted the VR simulation for surgical planning of the right side (Group B). After VR simulation, the same surgeon made the percutaneous punctures and placed the working channel on the right side of the specimen at all levels.ResultsAt the L3/L4 level, the puncture‐channel time was 11.36 ± 2.13 min in Group A and 11.29 ± 2.23 min in Group B (t = 0.097, P = 0.938). The exposure time was 17.21 ± 2.91 s in Group A and 14.64 ± 1.60 s in Group B (t = 2.534, P = 0.025). At the L4/L5 level, the puncture‐channel time was 13.86 ± 3.90 min in Group A and 11.93 ± 2.95 min in Group B (t = 2.291, P = 0.039). Exposure time was 20.64 ± 3.84 s in Group A and 16.43 ± 2.47 s in Group B (t = 6.118, P < 0.01). There were 7 patients undergoing foraminotomy in Group A and 3 patients undergoing foraminotomy in Group B (t = 2.280, P = 0.236). At the L5/S1 level, the puncture‐channel time was 18.21 ± 1.85 min in Group A and 15.71 ± 3.20 min in Group B (t = 2.476, P = 0.028). Exposure time was 26.07 ± 3.17 s in Group A and 22.50 ± 2.68 s in Group B (t = 2.980, P = 0.011). There were 14 patients receiving foraminotomy in Group A and 13 patients receiving foraminotomy in Group B (t = 1.000, P = 1.000).ConclusionsVirtual reality combined with isocentric navigation is feasible in TPED. It enables precise surgical planning and improves intraoperative procedures, and has the potential for application in clinical practice.

Biomechanical role of osteoporosis affects the incidence of adjacent segment disease after percutaneous transforaminal endoscopic discectomy

Study designVariation in the biomechanical characteristics of intervertebral discs adjacent to the segment disc after undergoing percutaneous transforaminal endoscopic discectomy (PTED) in models with normal and abnormal bone mineral density (BMD) was estimated using the finite element method.ObjectiveThe study investigated the change in the incidence of adjacent segment disease (ASD) after PTED in patients without and with osteoporosis.BackgroundsPTED has been widely used for treating lumbar disc herniation (LDH); changes in BMD will affect biomechanical characteristics, possibly leading to changes in the incidence of ASD after PTED. However, this issue remains largely unclear.MethodsA non-linear, lumbosacral finite element model was reconstructed based on imaging data and validated using compared values computed by the current model from published and well-validated, in vitro biomechanical experiment studies. Corresponding PTED models with normal and abnormal BMDs were also reconstructed. Shear and von Mises stresses on the annulus fibrosis, the von Mises stress on the endplates in L5–S1 segment discs, and the total deformation of current lumbosacral models were computed in different body positions by changing loading conditions, including flexion, extension, left and right lateral bending, and axial rotation.ResultsIn most loading conditions, biomechanical characteristics of the lumbosacral segment discs with normal BMDs after PTED slightly increased. However, in the PTED model with osteoporosis, most of the biomechanical characteristics dramatically increased.ConclusionOsteoporosis leads to the deterioration of biomechanical characteristics in the adjacent segment disc after PTED; this variation may also result in an increase in the incidence of ASD. However, further studies on the interactions between pathological changes are warranted.

A Cost-utility Analysis of Percutaneous Endoscopic Lumbar Discectomy for L5-S1 Lumbar Disc Herniation: Transforaminal versus Interlaminar.

A cost-utility analysis (CUA). The aim of this study was to evaluate the cost-effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) techniques for the treatment of L5-S1 lumbar disc herniation (LDH). The annual cost of treatment for lumbar disc herniation is staggering. As the two major approaches of percutaneous endoscopic lumbar discectomy (PELD): percutaneous endoscopic transforaminal discectomy (PETD) and percutaneous endoscopic interlaminar discectomy (PEID) have gained recognition for the treatment of L5-S1 lumbar disc herniation (LDH) and showed similar clinical outcome. ost-utility analysis (CUA) can help clinicians make appropriate decisions about optimal health care for L5-S1 LDH. Fifty and 25 patients were included in the PETD and PEID groups of the study. Patients' basic characteristics, health care costs, and clinical outcome of PETD and PEID group were collected and analyzed. Quality-adjusted life-years (QALYs) were calculated and validated by EuroQol five-dimensional (EQ-5D) questionnaire. Cost-effectiveness was determined by the incremental cost per QALY gained. The mean total cost of the PETD group was $5275.58 ± 292.98 and the PEID group was $5494.45 ± 749.24. No significant differences were observed in hospitalization expenses, laboratory and radiographic evaluations expenses, surgical expenses, and drug costs. Surgical equipment and materials costs, and anesthesia expense in the PEID group were significantly higher than in the PETD group (P < 0.001). Clinical outcomes, including Oswestry Disability Index (ODI), Visual Analogue Scale (VAS) scores, and Japanese Orthopaedic Association (JOA), also showed no significant differences between the two groups. The cost-effectiveness ratio of PETD and PEID were $6816.05 ± 717.90/QALY and $7073.30 ± 1081.44/QALY, respectively. The incremental cost-effectiveness ratios (ICERs) of PEID over PETD was $21887.00/QALY. Observed costs per QALY gained for L5-S1 LDH with PETD or PEID were similar for patients, demonstrating that the two different approaches of PELD are equally cost-effective and valuable interventions. 5.

Percutaneous endoscopic lumbar discectomy for LDH via a transforaminal approach versus an interlaminar approach: ameta-analysis.

The aim of this study was to systematically compare the safety and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) versus percutaneous endoscopic interlaminar discectomy (PEID) for the treatment of lumbar disc herniation (LDH). All studies that were performed to compare PETD with PEID to treat LDH and published until 31 August 2017 were acquired through acomprehensive search in various databases. Ameta-analysis was performed using the Cochrane Collaboration's RevMan5.3 software. Atotal of 13trials with 974 cases consisting of 3 randomized controlled trials, 3 prospective studies and 7 retrospective studies were included. The results suggest that patients treated with PEID experienced more significant advantages with shorter operation time, less intraoperative blood loss and less intraoperative fluoroscopy times but more complications than those treated with PETD; however, the two operative approaches did not significantly differ in terms of LDH recurrence, hospital stay, Oswestry disability index (ODI) scores, visual analogue scale (VAS) scores, Japanese Orthopaedic Association (JOA) scores and MacNab criteria at the final follow-up. Based on the results of this study, although PEID may be superior to PETD in certain ways, some of its advantages have yet to be verified and the two interventions were not significantly different in terms of relief of symptoms and functional recovery. Therefore, PEID would be recommended for treating LDH especially at L5/S1 under certain conditions but aprudent attitude is necessary to choose between the two operative approaches before alarge sample and high quality randomized controlled trials have been performed.

Traditional versus Percutaneous Transforaminal Endoforaminal Discectomy Effect on the Nervous System Function and Serum LEK, GFAP and PGE-2 in Patients with Senile Lumbar Spinal Stenosis.

To compare the influence of percutaneous transforaminal endoscopic discectomy (PTED) and traditional operation on the nervous system function and the serum leu-enkephalin (LEK), glial fibrillary acidic protein (GFAP) and prostaglandin E-2 (PGE-2) in patients with senile lumbar spinal stenosis. Experimental study. Department of Orthopedics Two, Xinjiang Changji Hui Autonomous Prefecture People's Hospital, Xinjiang, China, from March 2017 to March 2018. A total of 146 patients with senile lumbar spinal stenosis were randomly divided into control group and observation group, 73 in each group. Control group underwent traditional operation, while the observation group underwent PTED. General situation of operation, serum LEK, GFAP, PGE-2, American Spinal Injury Association (ASIA) score and Japanese Orthopaedic Association (JOA) score were compared. Intraoperative blood loss in observation group was less than that in control group (p<0.001). Both operation time and length of hospital stay in observation group were shorter than those in control group (both p<0.001). At 24 hours later after operation, both levels of serum LEK and ASIA score in observation group were higher than those in control group (p=0.006 and p<0.001, respectively), and levels of serum GFAP and PGE-2 and JOA score in observation group were all lower than those in control group (all p<0.001). Compared with traditional operation, PTED has the advantages of less intraoperative blood loss, shorter operation time and length of hospital stay, etc. Besides, PTED can effectively reduce serum LEK, BFGF and PGE-2 expression in patients; and dramatically improve their nervous system function and lumbar function.

Percutaneous Transforaminal Endoscopic Discectomy versus Micro-Endoscopic Discectomy for Lumbar Disc Herniation

BackgroundPercutaneous transforaminal endoscopic discectomy (PTED) and micro-endoscopic discectomy (MED) are alternative minimally invasive, widely performed procedures for the treatment of lumbar disc herniation (LDH). This study compared the clinical outcomes of these 2 surgical techniques in treating LDH.Material/MethodsA comprehensive literature search was performed in PubMed, MEDLINE, EMBASE, Cochrane, and Google Scholar to identify all relevant studies comparing PTED and MED in treating LDH.ResultsEight comparative studies assessing a total of 805 patients were included for the final analysis. The results indicated that PTED needs a shorter incision [−1.02 (−1.21 to −0.83), p<0.001], less time in bed [−2.14 (−3.34 to −0.94), p<0.001], and shorter hospital stay [−1.92 (−2.90 to −0.94), p<0.001], whereas MED is superior regarding intraoperative fluoroscopy [7.47 (2.78 to 12.17), p=0.002] and total cost [0.69 (0.38 to 1.00), p<0.001]. No significant differences were found on operation time, intraoperative blood loss, or complications. Significant lower back pain was found in the PTED group at 1 week postoperatively [−0.52 (−0.95 to −0.10), p=0.02] and 1 year postoperatively or the last follow-up [−0.41 (−0.76 to −0.06), p=0.02]; significant lower leg pain was also detected at 1 week postoperatively [−0.52 (−0.75 to −0.30), p<0.001]. Oswestry Disability Index (ODI) was significant better at 1 week postoperatively in the PTED group [−4.41 (−7.03 to −1.79), p=0.001]. No significant differences were detected at other time points regarding pain score and ODI.ConclusionsBoth PTED and MED are safe and effective techniques for treating LDH. However, taking all clinical outcomes together, PTED might be a preferable treatment modality for LDH.

Toxicity Effects of Methylene Blue on Rat Intervertebral Disc Annulus Fibrosus Cells

Background: There is an increasing local application of methylene blue (MB) in the treatment of discogenic low back pain (LBP) and percutaneous transforaminal endoscopic discectomy (PTED) procedures. MB could generate DNA damage and induce apoptosis in different cell types; however, the effects of MB on intervertebral disc (IVD) annulus fibrosus (AF) cells are not clearly understood. Objective: The objective of this study was to investigate the effects of different concentrations of MB on rat AF cells in vitro. Study Design: This study used an experimental design. Setting: This research was conducted at the Orthopaedic Institute of the Clinical Medical College of Yangzhou University. Methods: AF cells were isolated and cultured with different concentrations of MB (0, 2, 20, and 200 μg/mL) and assessed to determine the possible cytotoxic effects of MB. The cell proliferation was detected by Cell Counting Kit-8 (CCK-8) assay. The inverted phase-contrast microscopy was used to perform morphological observation of apoptotic cells, and flow cytometry was used to measure the incidence of cell apoptosis. The mRNA and protein expression levels of apoptosis-associated genes (caspase-3, Bcl-2, and Bax) and other related genes (collagen type I, transforming growth factor β1 [TGF-β1], fibroblast growth factor [bFGF], and tissue inhibitor of metalloproteinase-1 [TIMP-1]) were analyzed by quantitative real-time PCR (RT-PCR) and Western blotting. Results: Our results indicated that MB reduced cell viability in a concentration- and timedependent manner. MB also induced marked AF cell apoptosis in a concentration-dependent manner observed by inverted phase-contrast microscopy, flow cytometry, and indicated by the increased expression of caspase-3. Both RT-PCR and Western blotting revealed significant upregulation of Bax and caspase-3 expression levels accompanied by decreased expression of Bcl2 in a concentration-dependent manner. Moreover, collagen type I, TGF-β1, bFGF, and TIMP-1 mRNA and protein levels were also found to be decreased by MB in a concentration-dependent manner. Limitations: Limitations of this study were the in vitro study design and lack of in vivo validation of the observed effects of MB on human IVD cells. Conclusions: Our results indicate that a high concentration of MB can not only inhibit proliferation and paracrine function of AF cells, but can also induce cell apoptosis in a concentration-dependent manner, suggesting that it is necessary to choose low concentrations of MB in practical application and limit the use of MB in the treatment of discogenic LBP to research protocols. Key words: Methylene blue, annulus fibrosus cell, proliferation, apoptosis, paracrine

Overview of risk factors for failed percutaneous transforaminal endoscopic discectomy in lumbar disc herniation

The lumbar disc herniation is a common and recurrent disease in the department of orthopedics. At present, the treatment means mainly include conservative treatment and surgical treatment. Compared with traditional open surgery, percutaneous transforaminal endoscopic discectomy (PTED) is safe, effective, economical and minimally invasive. It is widely used in minimally invasive treatment of lumbar disc herniation. However, the clinical reports of the failure of PTED are also common. According to the research reports of domestic and foreign scholars, there are varieties of risk factors for surgical failures, including the selections of patients, indications, surgical approaches and anesthesia methods preoperative. Occurrences of surgical complications including infection or left pains, and reasonable rehabilitation exercise after the operation are related to failures. There is no unified conclusion at present. In this paper, we reviewed the literatures about failed PTED, and try to make an overview about the general situation of failed operation in clinical practice, the risk factors for failures and the countermeasures.

Percutaneous endoscopic transforaminal discectomy precedes interlaminar discectomy in the efficacy and safety for lumbar disc herniation.

We searched several databases from the times of their inception to 20 December 2018. Randomized controlled trials and cohort studies that compared percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) were identified. We used a random-effects model to calculate the relative risks (RRs) of, and standardized mean differences (SMDs) between the two techniques, with 95% confidence intervals (CIs). Twenty-six studies with 3294 patients were included in the final analysis. Compared with PEID, PETD reduced the short-term (SMD −0.68; 95% CI −1.01, −0.34; P=0.000) and long-term (SMD −0.47; 95% CI −0.82, −0.12; P=0.000) visual analog scale scores, blood loss (SMD −4.75; 95% CI −5.80, −3.71; P=0.000), duration of hospital stay (SMD −1.86; 95% CI −2.36, −1.37; P=0.000), and length of incision (SMD −3.93; 95% CI −5.23, −2.62; P=0.000). However, PEID was associated with a lower recurrence rate (P=0.035) and a shorter operative time (P=0.014). PETD and PEID afforded comparable excellent- and good-quality data, long- and short-term Oswestry disability index (ODI) scores, and complication rates. PETD treated lumbar disc herniation (LDH) more effectively than PEID. Although PETD required a longer operative time, PETD was as safe as PEID, and was associated with less blood loss, a shorter hospital stay, and a shorter incision. PETD is the best option for patients with LDH.

Effect of combination of lateral recess decompression by Tessys technique and PTED in patients suffering from contralateral symptoms of lumbar disc herniation

The aim was to explore the effect of lateral recess decompression by percutaneous transforaminal endoscopic spine system (Tessys) technique combined with percutaneous transforaminal endoscopic discectomy (PTED) on pain medium, nerve function and stress response in patients suffering from contralateral symptoms of lumbar disc herniation. A total of 96 patients with contralateral symptoms of lumbar disc herniation treated in our hospital from February 2015 to April 2017 were randomly divided into control group and study group, with 48 cases in each group. The control group underwent PTED, and the study group underwent lateral recess decompression by Tessys technique combined with PTED. The visual analogue scale (VSA) score and Japanese Orthopaedic Association (JOA) score before surgery and 3 months after surgery were compared between the two groups. The levels of serum pain medium (prostaglandin E2 (PGE2), histamine (HA), 5-hydroxytryptamine (5-HT)) and oxidative stress indexes (malondialdehyde (MDA), myeloperoxidase (MPO), superoxide dismutase (SOD), total antioxidant capacity (TAC)) before surgery and 7 days after surgery were compared. The clinical efficacy of the two groups was compared at 1 month after treatment. One month after treatment, the excellent and good rate in the study group was significantly higher than that in the control group (85.4% vs 56.3%; P &lt; 0.05). There was no significant difference between VAS and JOA score in the two groups preoperatively ( P &gt; 0.05). At 3 months after surgery, the VAS score in the study group was significantly lower than that in the control group ( P &lt; 0.05), and the JOA score in the study group was significantly higher than that in the control group ( P &lt; 0.05). There was no significant difference in serum PGE2, HA and 5-HT levels between the two groups preoperatively ( P &gt; 0.05). At 7 days after surgery, the serum PGE2, HA and 5-HT levels in the study group were significantly lower than those in the control group ( P &lt; 0.05). Preoperatively, the levels of serum MDA, MPO, SOD and TAC were not significantly different between the two groups ( P &gt; 0.05). On the seventh day after surgery, the levels of serum MDA and MPO in the study group were significantly lower than those in the control group ( P &lt; 0.05), and the levels of SOD and TAC were significantly higher than those in the control group ( P &lt; 0.05). In conclusion, the combined therapy of lateral recess decompression by Tessys technique and PTED in patients suffering from contralateral symptoms of lumbar disc herniation has a definite clinical effect, which can significantly alleviate the symptoms of low back pain and motor nerve function and reduce the contents of serum pain medium and the levels of oxidative stress. It is worthy of clinical promotion.

A comparative study on short-term therapeutic effects of percutaneous transforaminal endoscopic discectomy and microendoscopic discectomy on lumbar disc herniation.

Objective:To find out the short-term effects of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) on lumbar disc herniation (LDH).Methods:Ninety LDH patients treated in PLA Army General Hospital from July 2015 to July 2016 were selected and randomly divided into an MED group and a PTED group. Length of incision, amount of intraoperative bleeding, surgical time, number of times using intraoperative fluoroscopy, postoperative bedridden time, hospital stay, together with visual analogue scale (VAS) and Oswestry disability index (ODI) scores before surgery, three days, three months and six months after surgery were analyzed.Results:As regards the length of surgical incision, amount of bleeding, postoperative bedridden time and hospital stay, the PTED group was significantly superior to the MED group ((P=0.000, 0.000, 0.000, 0.001, respectively)). Compared with the PTED group, the MED group used less fluoroscopy and had shorter surgical time (P=0.001, 0.000, respectively). The postoperative VAS and ODI scores of both groups were significantly improved compared with those before surgery (P<0.000, 0.000, respectively). The short-term postoperative low back pain (LBP) VAS score of PTED group was lower than that of MED group (P=0.001). The two groups had similar leg pain (LP) VAS score three and six months after surgery, postoperative and follow-up LP VAS and ODI scores, and surgical improvement rate (P=0.093, 0.097, respectively).Conclusion:LDH was effectively treated by both PTED and MED. Compared with MED, PTED had less trauma, less blood loss, and faster recovery after surgery.

经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的Meta分析

经皮椎间孔镜与椎板开窗术治疗腰椎间盘突出症的Meta分析

运用椎间孔镜术和开放式椎间盘切除术治疗青少年腰椎间盘突出症疗效研究

运用椎间孔镜术和开放式椎间盘切除术治疗青少年腰椎间盘突出症疗效研究

Application progress of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar intervertebral disc herniation

Lumbar intervertebral disc herniation (LDH) is a syndrome caused by various reasons such as nucleus pulposus protrusion, compression of nerve root and herniation of nucleus pulposus, and stimulation of nerve root and cauda equina nerve. It is one of the most common diseases in orthopedics. There are a variety of surgical treatments for this disease, including traditional open surgery and minimally invasive techniques. At present, the minimally invasive technique represented by percutaneous transforaminal endoscopy has gradually replaced the traditional open surgery as the mainstream because of its advantages of less trauma, faster recovery and fewer complications. This article will systematically expound the application and progress of percutaneous lumbar intervertebral foraminoscopy in the treatment of lumbar disc herniation from the development course, indications, operation skills, matters needing attention, curative effect analysis, complications and so on. Key words: Lumbar vertebrae/SU; Intervertebral disk displacement/SU; Diskectomy, percutaneous; Endoscopy; Review

Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases

To explore the clinical effect of percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia for lumbar disc herniation in elder with systemic diseases. The clinical data of 44 elder patients with lumbar disc herniation and systemic diseases treated from June 2013 to June 2017 were retrospectively analyzed. Including 26 males and 18 females, aged 70 to 86 years old with an average of(77.5±3.5) years, course of disease was 3 weeks to 6 months. Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia was performed in the patients. Postoperative straight leg-raising degree change and Nakai criteria were used to evaluate the operative effect. Visual analogue scale(VAS) and JOA scoring system were used to compare the symptom improvement between preoperative and postoperative. No serious complications occurred during and after the operation, and the coexisting medical diseases were not aggravated. All patients safely survived the perioperative period. All the 44 cases were followed up from 6 to 30 months with an average of 20 months. Postoperative straight leg raising angle was obviously improved. At final follow-up, according to Nakai standard, 41 cases got excellent results, 3 good. VAS scores were significantly decreased and JOA scores were significantly increased in final follow-up(P<0.01). Percutaneous transforaminal endoscopic discectomy via lateral position assisted with local anesthesia is a safe, effective, less invasive technique for the treatment of lumbar disc herniation in elder with systemic diseases. Multidisciplinary collaboration and perioperative well controlled disease are essential for early rehabilitation of such patients.

Percutaneous transforaminal endoscopic discectomy in the treatment of senior patients with lumbar degenerative disc disease.

The aim of the current study was to analyze the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of lumbar degenerative disc disease for senior patients. The clinical and follow-up data of senior patients were retrospectively reviewed. Patients were divided into a PTED group and an open surgery group. Parameters were analyzed, including surgery time, intraoperative fluoroscopy time, intraoperative blood loss, postoperative complications, visual analog scale (VAS) and Japan Orthopedic Association (JOA) scores. Compared with the open surgery group, the surgery time and intraoperative blood loss were decreased, while the intraoperative fluoroscopy time was increased, in the PTED group (P<0.001). Significant improvements in VAS and JOA scores were identified within both groups from preoperative to 12 months following surgery (P<0.001). VAS and JOA scores were significantly improved in the PTEN group compared with the open surgery group at 1 week after surgery (P<0.001), but there was no significant difference between groups prior to and at 12 months following surgery. The incidence of venous thrombosis of the lower extremities in the PTED group was decreased compared with the open surgery group (P<0.05). In the open surgery group, patients suffered from multiple postoperative complications, including constipation, urinary system infection, wound infection, gastrointestinal hemorrhagic stress ulcer, pneumonia, pulmonary embolism, mortality following myocardial infarction, mortality following cerebral infarction, and hemiplegia following cerebral hemorrhage. By contrast, patients in the PTED group did not experience any of these complications. In conclusion, PTED resulted in reduced trauma and a lower incidence of severe complications compared with open surgery, which suggests that PTED is a safe and effective minimally invasive surgery for senior patients with lumbar degenerative disc disease.

Percutaneous Endoscopic Lumbar Discectomy in Treating Calcified Lumbar Intervertebral Disc Herniation

We retrospectively analyzed and report the clinical results of percutaneous endoscopic lumbar discectomy (PELD) in treating patients with calcified lumbar intervertebral disc herniation (CLDH). The data from 40 patients with CLDH treated with PELD in our hospital from June 2013 to June 2017 were reviewed. Of the 40 patients, 27 (19 men; 8 women; average age, 45.5 ± 7.5 years) had undergone percutaneous endoscopic transforaminal discectomy and 13 (8 men, 5 women; average age, 46.9 ± 6.9 years) had undergone percutaneous endoscopic interlaminar discectomy. The Peak method was used for both groups. The preoperative demographic data of both groups were analyzed. The pre- and postoperative leg visual analog scale scores and Oswestry disability index were compared and complications were evaluated. All procedures were performed successfully, and follow-up data were obtained for all patients for 24 months. The leg visual analog scale and Oswestry disability index scores at the last follow-up visit had decreased in both groups and were significantly different statistically from the preoperative data. No nerve root injury, intestinal injury, intervertebral disc infection, or recurrence was detected in any patient. Dural tear and cerebrospinal fluid leakage were observed in 3 patients (2, percutaneous endoscopic transforaminal discectomy; 1, percutaneous endoscopic interlaminar discectomy), because of adhesions between the calcification and nerve root. However, their symptoms resolved, and they were discharged after 1 week of bed rest. With the application of Peak philosophy, PELD is safe and effective in treating patients with CLDH. The use of PELD results in good neurological recovery, pain relief, and a low incidence of complications.

A multicenter retrospective clinical study on "symptomatic facet of residual bone mass", a rare complication of percutaneous trasforaminal endoscopic discectomy

Objective Retrospective study and report on cases of symptomatic facet of residual bone caused by percutaneous transforaminal endoscopic discectomy (PTED), to analysis of its causes and revision strategies. Methods Seven cases of symptomatic facet of residual bone after PTED were found in six medical centers from July 2015 to November 2017.Weintroduced the course of diagnosis and treatment, to analysis of the causes, clinical features and revision strategies of the rare complication. Results Seven patients came from different medical centers (2 cases in Ningbo No.6 Hospital and 1 case in each of the other medical centers). The average age of the subject is 67.29±9.64 years (range from 57-83 years). Among them there were 1 male and 6 female. PTED was performed for all cases with lumbar disc herniation or stenosis. The operative segments were 1 of L2,3, 2 of L3,4, 3 of L4,5, 1 of L5S1. Symptoms occurred immediately after surgery in all cases except one after a week of operation and another one month later. Two cases were appeared symptom of contralateral irritation, and the rest were aggravated by the original symptoms. Two cerebrospinal fluid leakage caused by bone mass piercing the dural sac. The bone mass compressed the nerve root and caused 1 case of lower limb muscle weakness. Foraminoplasty was performed during PTED in all patients. After CT scan, 5 cases of bone mass were found on the same side of operation, and 2 cases were in the contralateral side. The shortest time for revision was 2 days and the longest 3 months. After conservative treatment, the symptoms were relieved in only one case. Revision surgeries were performed for all the other 6 cases, 2 with microendoscopic discectomy (MED), 1 mobile microendoscopic discectomy (MMED), 1 small incision operation, 1 PTED and 1 with minimal invasive surgery of transforaminal lumbar intervertebral fusion (MIS-TLIF). The VAS scores of low back pain and leg pain was significantly relieved from 8.67±0.52 to 1.50±0.55. Conclusion PTED may lead to residual bone mass in lumbar foraminoplasty. The penetration of the bone mass block into the spinal canal can cause the compression symptoms of the corresponding segment. The patients showed the corresponding spinal canal stenosis and nerve root irritation symptoms. A revision operation is required to remove the oppressed bone mass to relieve the symptoms as soon as possible if the conservative treatment not effective. Key words: Zygapophyseal joint; Multicenter study; Treatment outcome

"U" route transforaminal percutaneous endoscopic thoracic discectomy as a new treatment for thoracic spinal stenosis.

To describe the rationale, surgical technique, and short-term follow-up results of a new minimally invasive treatment for thoracic spinal stenosis (TSS) caused by herniation, ossification of the ligamentum flavum (OLF), and/or ossification of the posterior longitudinal ligament (OPLL) with a "U" route transforaminal percutaneous endoscopic thoracic discectomy (PETD). Fourteen patients, including seven males and seven females, underwent "U" route PETD. Myelopathy was caused by OLF in 14 patients, OPLL in one, combined OLF-OPLL in ten, and intervertebral disc herniation (IDH) in five. Decompression was performed in one segment in 12 patients, and in two segments in two patients. The Japanese Orthopedic Association (JOA) scores, visual analog scale (VAS) scores, and complications were documented. The JOA scores improved from 4.64 ± 2.31 pre-operatively to 7.07 ± 1.59 one day post-operatively and 11.79 ± 1.85 at final follow-up. The difference between pre-operation and post-operation was statistically significant (P < 0.05). Moreover, the VAS score was 6.07 ± 2.06 points pre-operatively, decreasing to 3.00 ± 1.24 points at one day post-operatively, and 1.14 ± 0.86 points at last follow-up (P < 0.05). Dural tear was observed in two cases during the intervention. No patient had transient worsening of pre-operative paralysis. This retrospective analysis shows that "U" route PETD for decompression may be a feasible alternative to treat thoracic spinal stenosis.

Concentric Stereotactic Technique of Percutaneous Endoscopic Transforaminal Discectomy and Radiation Exposure to Surgeons

In percutaneous endoscopic transforaminal discectomy (PETD), surgeons are exposed to intraoperative radiographic radiation over a long-term career, which may be correlated with high risk of iatrogenic radiation hazards. The purpose of this prospective cohort study was to assess the impact of concentric stereotactic technique on radiation exposure to surgeons in PETD. Patients who underwent conventional PETD were regarded as group A, whereas those undergoing PETD with concentric stereotactic technique were considered as group B. The primary outcomes were cumulative radiation dose to the surgeon's eye, thyroid gland, and breast. A total of 34 patients were treated in group A and 30 patients were treated in group B. The cumulative radiation dose of the eye per operation was 0.017 (0.58/34) mSv in group A and 0.010 (0.31/30) mSv in group B, which meant a reduction of 41.18%. The cumulative radiation dose of the thyroid gland per operation was 0.018 (0.60/34) mSv in group A and 0.011 (0.33/30) mSv in group B, which meant a reduction of 38.89%. The cumulative radiation dose of the chest per operation was 0.039 (1.33/34) mSv in group A and 0.023 (0.70/30) mSv in group B, which meant a reduction of 41.03%. There were no significant differences in hospital stay, visual analog scale score of waist and leg pain, Oswestry Disability Index score, MacNab satisfaction, and complications between the 2 groups (P > 0.05). The concentric stereotactic technique can effectively reduce radiation exposure to surgeons by about 40%.