Percutaneous Transforaminal Endoscopic Discectomy Research Articles

Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microscope‐Assisted Tubular Discectomy for Lumbar Disc Herniation

ObjectiveThe aim of the present study was to compare the clinical outcomes and quality of life following percutaneous transforaminal endoscopic discectomy (PTED) and microscope‐assisted tubular discectomy (MTD) for lumbar disc herniation (LDH).MethodsThis study had a retrospective design. From June 2017 to June 2018, the clinical data of 120 patients with LDH treated with PTED (60 cases, PTED group) and MTD (60 cases, MTD group) were analyzed and followed up for at least 20 months. There were 59 men and 61 women. Patients were aged between 22 and 80 years. The operation time, intraoperative blood loss, incision length, frequency of intraoperative fluoroscopy, cost, hospital stay, types of herniated discs, complications, and clinical outcomes were evaluated. Clinical outcomes were assessed using the visual analog scale (VAS), the Oswestry disability index (ODI), and the modified Macnab criteria. Short‐Form 36 (SF‐36) and the EQ‐5D‐5L were used to evaluate the quality of life of patients. The data between the two groups were compared by independent sample t‐tests. Multiple comparisons between samples were analyzed by analysis of variance.ResultsCompared with the MTD group, the PTED group had shorter incision length (9.20 ± 1.19 mm vs 26.38 ± 1.82 mm), less intraoperative blood loss (18.00 ± 4.97 mL vs 39.83 ± 6.51 mL), and shorter hospital stay (5.42 ± 5.08 days vs 10.58 ± 3.69 days) (P = 0.00). PTED was much more appropriate for foraminal and extraforaminal disc herniation. The incidence of paresthesia was lower in the PTED group (6.67% vs 16.67%). At each follow up, the VAS and ODI scores of all patients were significantly improved compared with those before surgery (P = 0.00). At 3 days postoperatively, the lumbar VAS score of the PTED group was significantly lower (1.58 ± 1.00 vs 2.37 ± 1.10, P = 0.00). The excellent rate of the PTED group reached 91.67%, and that of the MTD group reached 93.33%. Compared with the preoperative SF‐36 scores for physiological function, mental health, and social function, the postoperative scores were significantly improved in both groups (P = 0.00). The EQ‐5D‐5L in the PTED group increased from 0.30 ± 0.17 before the operation to 0.69 ± 0.13 after 6 months of follow up (P = 0.00) and 0.73 ± 0.14 after 20 months of follow up. The EQ‐5D‐5L in the MTD group increased from 0.28 ± 0.17 before the operation to 0.68 ± 0.13 after a 6‐month follow up (P = 0.00), and 0.73 ± 0.12 after a 20‐month follow up.ConclusionAlthough both PTED and MTD are effective for LDH, PTED is much more appropriate for various types of LDH and has the advantages of the low incidence of low back pain, fewer complications, and early recovery.

Feasibility and surgical technique of percutaneous transforaminal discectomy for the treatment of lumbar disc herniation

Percutaneous transforaminal endoscopic discectomy (PTED) is an alternative minimally invasive technique for the treatment of lumbosacral radicular syndrome resulting from lumbar disc herniation. The latter is performed with the help of local anesthesia and sedation in an awake patient with the advantage of direct feedback. Access to the target is lateral and follows a safe trajectory through the Kambin triangle. The main advantages of this surgical technique are the possibility of early discharge within 2 hours after its completion, negligible blood loss, lower risk of infectious complications, convenience in patients with obesity, reduced risk of epidural fibrosis. There are currently no large randomized trials of good quality demonstrating the advantage of PTED over open interlaminar access established in practice. In the worst case, endoscopic discectomy is not known to pose additional risks to patients. The operative technique with a clinical case and a discussion about the applicability of the new approach for the treatment of lumbar disc herniations are presented.

Pathomechanism of Lower-level Discogenic Groin Pain and Clinical Outcomes of Percutaneous Endoscopic Discectomy for the Treatment of Discogenic Groin Pain

Groin pain can be induced by high-level (L1-L2 or L2-L3) lumbar disc herniation. However, 4.1% of patients with lower-level (L4-L5 or L5-S1) lumbar disc herniation also complained of groin pain. The pathomechanism of groin pain occurring due to lumbar disc herniation at and below the L4-5 levels is still unclear. To investigate the afferent pathways of lower-level lumbar disc herniation induced groin pain. And evaluate the clinical results of transforaminal endoscopic discectomy treatment for discogenic groin pain. This retrospective observational study used an experimental design (institutional review board: HROH 201-C2-100). The research took place in the Laboratory Research Center and spine center at The First Affiliated Hospital of Harbin Medical University. Firstly, 14 adult Wistar rats were randomly divided into 2 groups: control group (the paravertebral sympathetic trunks were preserved) and experimental group (the paravertebral sympathetic trunks were resected). All Wistar rats were intraperitoneally anesthetized, and then 1 (mu)L of fast blue was injected into the dorsal rami of L2 spinal nerves on the right side. Forty hours later, 2 (mu)L of nuclear yellow was injected into the right posterior portion of the L5-L6 intervertebral disc. The L1 and L2 spinal ganglia were sectioned 8 hours later to observe fluorescently double-labeled cells and the effect of paravertebral sympathetic trunk resection. Secondly, 14 adult Wistar rats were anesthetized, and the right posterior portion of the L5-L6 intervertebral disc was electrostimulated to observe potential changes in the genitocrural nerve in the ipsilateral inguinal region. To evaluate the clinical outcomes of transforaminal endoscopic discectomy for the treatment of discogenic groin pain, between September 2015 and May 2017, transforaminal endoscopic discectomy was performed on 30 patients with lower-level discogenic groin pain. Outcomes were analyzed utilizing the visual analog scale, Oswestry disability index, and MacNab Criteria. The total proportion of cells in the right L1 and L2 spinal ganglia with fast blue/nuclear yellow double labeling was 3.33% and 3.41% (48 and 56), respectively. The number of fluorescently double-labeled cells in the resected paravertebral sympathetic trunk group was significantly less (P < 0.01). Electrical stimulation of the right posterior portion of the L5-L6 intervertebral disc could elicit action potentials in the ipsilateral genitofemoral nerve. All patients were followed for 12 months, and the visual analog scale score at 1 week, 1 month, 3 months, 6 months, and 12 months after the operation was 0.79 ± 0.55, 0.54 ± 0.55, 0.47 ± 0.65, 0.51 ± 0.65, and 0.69 ± 0.55, respectively, showing a significant decrease compared with the preoperative visual analog scale score (P < 0.01). Based on the MacNab scoring system, the effective rate was 100%, and the rate of good and excellent results was 93.3%. A relatively small number of patients and a short follow-up period. Discogenic groin pain is transmitted by sympathetic nerves and appears in the area segmentally innervated by the anterior rami of the L1 and L2 spinal nerves. Posterolateral percutaneous transforaminal endoscopic discectomy and radiofrequency thermal annuloplasty are effective minimally invasive alternative treatments for discogenic groin pain.

The role of positive nerve root sedimentation sign in the treatment of patients undergoing lumbar disc herniation

Background To investigate the efficacy of percutaneous transforaminal endoscopic discectomy (PTED) in the treatment of patients who were diagnosed with lumbar disc herniation (LDH) with positive nerve root sedimentation sign (NRSS). Methods A total of 86 patients who underwent LDH were recruited and divided into NRSS-positive group (n = 49) and NRSS-negative group (n = 37). The visual analog scale (VAS), Japanese Orthopaedic Association (JOA), and Oswestry disability index (ODI) were used to evaluate the low back pain and functional recovery and were compared between the two groups. Results There were no significant differences in the demographic parameters between the two groups. The average area of the dural sac compression in the NRSS-positive group was significantly higher than that in the NRSS-negative group. Patients with a positive NRSS showed a better low back pain relief than those with a negative NRSS at 1 week and 1 month after surgery. The JOA and ODI in the NRSS-positive group were better than those in the NRSS-negative group at 3 months and 6 months postoperatively. The apparent efficiency of JOA and the excellent and good rate of ODI in the negative group was lower than that in the positive group at 6 months after surgery. Conclusions Patients undergoing LDH with a positive NRSS showed better pain relief and functional recovery than those with a negative NRSS. The present study suggested that NRSS might be a valuable sign and associated with better clinical outcomes in patients undergoing LDH with the treatment of PTED.

Transforaminal percutaneous endoscopic discectomy for symptomatic gas-filled discal cysts\u2014report of three cases and literature review

ObjectiveThe aim of this retrospective study is to review our experience in the diagnosis and role of transforaminal percutaneous endoscopic discectomy (TPED) for symptomatic gas-filled discal cysts.MethodsBetween May 2014 and June 2017, 3 patients from Lishui Center Hospital (Lishui China), who underwent TPED for symptomatic gas-filled discal cysts, were analyzed. The clinical features, imaging findings, operative findings, and treatment outcomes are presented. In addition, relevant literature regarding gas-filled discal cysts was searched using PubMed, and their characteristics, clinical features, therapeutic strategies, and survival outcomes were reviewed.ResultsThe median age of the patients was 56.7 years (range, 55–60 years). In all patients, a discal cyst was located in the lumbar region, and the patients presented with backache and numbness in the lower extremities. The diagnosis was made by lumbar 3-dimensional computed tomography (3D-CT) or magnetic resonance imaging (MRI). All patients underwent TPED. All patients recovered successfully and were eventually discharged. Eighteen articles were identified from the searches of the database, and a total of 42 patients were included. There were 28 males and 14 females. The mean age was 56.8 years, ranging from 27 to 85 years. Lower back pain was the major symptom. Twenty-two patients underwent surgery, 4 patients underwent percutaneous needle aspiration, 2 patients underwent drug therapy, 13 patients received nonoperative treatment, and 1 patient was unknown.ConclusionTPED for gas-filled discal cysts is feasible, effective, and successful, although it should be performed by an experienced surgeon with awareness of the potential risk of severe nerve root injury.

Percutaneous Endoscopic Lumbar Discectomy via Transforaminal Approach Combined with Interlaminar Approach for L4/5 and L5/S1 Two-Level Disc Herniation.

ObjectiveThe purpose of the present study was to discuss a new surgical strategy that combines percutaneous endoscopic transforaminal discectomy (PETD) with percutaneous endoscopic interlaminar discectomy (PEID) for L4/5 and L5/S1 two‐level disc herniation.MethodsThis was a retrospective study. A total of 19 patients with L4/5 and L5/S1 two‐level lumbar disc herniation (LDH) who underwent percutaneous endoscopic lumbar discectomy (PELD) in our hospital from January 2015 to June 2016 were retrospectively examined. The average age of these 19 patients was 42.21 ± 14.88 years old, including 12 men and 7 women. One experienced surgeon who had carried out more than 3000 lumbar surgeries performed PELD for these patients. During the PELD surgery, the transforaminal approach was adopted for L4/5 level disc herniation and the interlaminar approach was adopted for L5/S1 level disc herniation. The demographic data, operation time (min), fluoroscopy times, hospital stay (days), and complications were recorded and analyzed. The visual analogue scale (VAS), Oswestry disability index (ODI) scores, and the modified MacNab criteria were used to evaluate the surgical outcomes. MRI was conducted to evaluate the radiographic improvement.ResultsAll patients underwent PELD via the transforaminal approach combined with the interlaminar approach successfully and achieved satisfactory efficacy. The follow‐up points were 3, 12, and 18 months. The average hospital stay (days) and the average follow up (months) were 3.32 ± 0.98 and 18.63 ± 3.84, respectively. The operation time and fluoroscopy times were 85.79 ± 12.90 min and 39.05 ± 4.59 times, respectively. The fluoroscopy times (frequency) for L4/5 and L5/S1 were 26.95 ± 6.41 and 12.11 ± 3.49 (t = 7.00, P < 0.05). Furthermore, there was no significant difference for fluoroscopy times between male and female patients (t = 0.89, P = 0.99). The preoperative back pain (VAS‐Back) and the last follow‐up VAS‐Back were 5.58 ± 2.01 and 2.37 ± 1.01, respectively (t = 7.14, P < 0.05). The preoperative leg pain (VAS‐Leg) and the last follow‐up VAS‐Leg were 7.00 ± 1.56 and 1.63 ± 1.01, respectively (t = 20.97, P < 0.05). There were significant differences between preoperative VAS‐Back and the last follow‐up VAS‐Back in men (t = 4.61, P < 0.05) and women (t = 6.57, P < 0.05). In addition, there was significant differences between preoperative VAS‐Leg and the last follow‐up VAS‐Leg in men (t = 13.48, P < 0.05) and women (t = 26.87, P < 0.05). There were significant differences between preoperative ODI scores (44.84 ± 10.82%) and the last follow‐up ODI scores (11.12 ± 5.80%) (t = 10.92, P < 0.05). Preoperative ODI scores and the last follow‐up ODI scores were significantly different for men (t = 8.80, P < 0.05) and women (t = 6.63, P < 0.05). All patients received significant pain relief and functional improvement after the surgery. Except for two cases of postoperative dysesthesia and one dural tear, no severe complications occurred. The dysesthesia symptoms of these two patients disappeared within 1 week with the application of dexamethasone and neurotrophic drugs and the dural tear case also recovered well as the dural laceration was small. No poor results were reported and 89.47% of patients achieved excellent or good recovery.ConclusionPercutaneous endoscopic lumbar discectomy via the transforaminal approach combined with the interlaminar approach under epidural anesthesia can treat L4/5 and L5/S1 two‐level disc herniation safely and effectively.

Nerve recognition in percutaneous transforaminal endoscopic discectomy using convolutional neural network.

Percutaneous transforaminal endoscopic discectomy (PTED) is one of the most common minimally invasive surgery methods used in clinic in recent years. In this study, we developed a computer-aided detection system (CADS) based on convolutional neural network (CNN) to automatically recognize nerve and dura mater images under PTED surgery. We collected surgical videos from 65 patients with lumbar disc herniation who underwent PTED; we then converted the videos into images, and randomly divided some images into a training dataset, a validation dataset, test dataset. The training dataset and validation dataset were composed of 10454 images containing nerve and dura mater from 50 randomly selected patients; test dataset contained 12000 images from the remaining 15 patients. The results showed that sensitivity, specificity, and accuracy reached 90.90%, 93.68%, and 92.29%, respectively. CADS could recognize the nerve and dura mater with no significant difference (P>0.05) between each patient in test dataset. In comparison with clinicians of different levels, the performance of CADS was lower than that of a spinal endoscopist, but significantly higher than that of general surgeons. With the assistance of CADS, the performance of the general surgeons approached that of the spinal endoscopist. CNN can recognize well nerve and dura mater images in PTED surgery, and can help general surgeons to improve their ability to recognize tissues during the operation.

Результаты трансфораминального эндоскопического удаления грыжи диска пояснично- крестцового отдела позвоночника, дополненного нуклеопластикой

Introduction Herniated disks are very common. Percutaneous endoscopic lumbar spine surgery for the lumbar disc herniation facilitates minimalized access ports to the operating site with decreased risk of infection, reduced blood loss and less tissue dissection and muscle trauma. The goal was to compare the results of standard transforaminal endoscopic discectomy for lumbosacral herniation and outcomes of the procedure added by nucleoplasty. Material and methods Percutaneous transforaminal endoscopic discectomy was performed for 92 patients and added by nucleoplasty in 43 patients of group I. Preoperative and postoperative evaluation was produced with the Visual Analog Pain Scale (VAS), the Oswestry Low Back Pain Disability Questionnaire (ODI) and the MacNab clinical outcome score. Complication and recurrence rate was reviewed. Microsoft Office Excell and Statistica 8.0 were used to complete data analysis reports. Results VAS scores decreased from 7.9 to 3.1 showing 2.5-fold decrease (p &lt; 0.05), and ODI scores decreased from 71.09 to 18.58) (p &lt; 0.001) demonstrating fourfold decrease at one-year follow-up. There were no significant differences in VAS and ODI scores between the groups preoperatively and postoperatively (p &gt; 0.05). The majority of patients of group I (41.86 %) rated their health status as excellent on the MacNab scale, and the majority of patients of group II (53.06 %) rated their health status as good. Postoperative complication rate was 11.63% in group I and 12.24% in group II (p &gt; 0.05). There was no recurrence in group I with the recurrence rate of 6.1% (p &lt; 0.001) in group II. Conclusion Endoscopic discectomy for lumbosacral herniation supplemented with nucleoplasty can reduce the recurrence rate.

Letter to the editor on “Does anxiety influence the prognosis of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation? A preliminary propensity score matching analysis”

Letter to the editor on “Does anxiety influence the prognosis of percutaneous transforaminal endoscopic discectomy in the treatment of lumbar disc herniation? A preliminary propensity score matching analysis”

Meta-analysis of the operative treatment of lumbar disc herniation via transforaminal percutaneous endoscopic discectomy versus interlaminar percutaneous endoscopic discectomy in randomized trials.

Backgrounds:Transforaminal percutaneous endoscopic discectomy (TF-PELD) and interlaminar percutaneous endoscopic discectomy (IL-PELD) are the most common alternative treatments of lumbar disc herniation. The aim of this study was to compare the operation time duration and X-ray exposure as well as outcomes of TF-PELD and IL-PELD as indicated by the published clinical evidences within randomized trials.Methods:We included randomized, controlled studies reporting operation duration and X-ray exposure as well as clinical outcome evaluations, comparing TF-PELD to IL-PELD with a minimum of 10 patients per group. The included data measures were operation duration, X-ray exposure and postoperation evaluations. Data were synthesized and analyzed using ReviewManager version 5.3. Publication bias was evaluated via funnel plot. The Cochran Q test and the degree of inconsistency (I2) were used to assess heterogeneity. Lowly biased and heterogenous dichotomous data were calculated by odds ratio and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI).Results:Thirteen studies published from January 1970 to March 2018, with a total of 770 lumbar disc herniation patients, including 361 cases of TF-PELD and 409 cases of IL-PELD, were finally included. Meta-analysis of data extracted from these studies revealed that the postoperation outcomes of both surgery methods did not differ significantly, but the surgery duration was significantly shorter in the IL-PELD group than in the TF-PELD group (MD 21.69; 95% CI 12.94–30.27; P = .00001), and the fluoroscopy times demanded in the IL-PELD group was significantly fewer than those in the TF-PELD group (MD 7.57; 95% CI 6.22–8.93; P = .00001).Conclusion:The main finding of the study is that IL-PELD approach can decrease radiation exposure as their demanded duration of operation and fluoroscopy times were significantly shorter and fewer in the IL-PELD group, which they achieve similar outcomes comparing to TF-PELD. The study is limited at a lack of samples with lumbar disc herniation levels out of L5/S1. The findings implicate selection of IL-PELD approach over TF-PELD at applicable circumstances for lower lumbar disc herniation. Physicians should consider this data when choosing between TF-PELD and IL-PELD.

Comparison of the application value of two commonly used minimally invasive spinal surgery in the treatment of lumbar disc herniation.

The aim of the study was to compare the application value of percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) in the treatment of lumbar disc herniation (LDH). From January 2017 to July 2018, 108 LDH patients undergoing surgical treatment in our hospital were collected and divided into PTED group (treated with PTED, n=50) and MED group (treated with MED, n=58). The operation parameter index level, complications, recurrence and pain score (VAS), Oswestry disability index (ODI) and Japanese Orthopaedic Association Scale (JOA) were compared between the two groups. VAS, ODI and JOA scores of the two groups were significantly decreased after operation (P<0.05), but there was no significant difference between the two groups (P>0.05). Complications and recurrence of the two groups were similar (P>0.05). MED was superior to PTED in the number of intraoperative fluoroscopy and operation time, while PTED was superior to MED in intraoperative blood loss, incision length, length of hospital stay and bed rest time (P<0.05). Both PTED and MED can effectively treat LDH. Referring to clinical data, PTED may be the first choice for LDH treatment.

Biomechanical affect of percutaneous transforaminal endoscopic discectomy on adjacent segments with different degrees of degeneration:a finite element analysis

To investigate the biomechanical affect of percutaneous transforaminal endoscopic discectomy(PTED) on adjacent segments with different degrees of degeneration and related risk of adjacent segment diseases (ASD) caused by this operation. A healthy male adult volunteer was selected, and the lumbosacral vertebra image data was obtained by CT scan, and the external contour of the bone structure was reconstructed. On this basis, the external contour of the bone structure was fitted by using the smooth curve in 3D-CAD software, and the complete three-dimensional finite element modelof the non degenerate L3-S1 segment and the degenerative models of the L3-L4 and L5-S1 segment were drawn forward. In L4, L5 segment simulating PTED surgery through the removal of right part of articular process and nucleus pulposus and anulus fibrosus. After PTED was simulated in the L4-L5 segment and the risk of ASD has been evaluated by six changes of biomechanical indicators in flexion, extension, left and right lateral bending, left and right axial rotation conditions. In the finite element model without adjacent segmental disc degeneration, the annulus fibrosus von Mises stress and intradiscal pressure of the PTED model showed only a slight increase under most stress conditions, and a slight decrease in a few conditions, and there was no significant change trend before and after surgery. In the original degenerated adjacent segment disc model, the biomechanical indicators related to disc degeneration in the pre- and post-PTED model showed significant deterioration, leading to an increased risk of potential adjacent spondylopathy. PTED surgery will not lead to the significant deterioration of postoperative biomechanical environment of non-degeneration adjacent intervertebral discs, and the original degeneration of adjacent intervertebral discs is a important risk factor for ASD.

Quantitative Evaluation of Intraspinal Lumbar Disc Herniation-related Lumbosacral Radiculopathy Before and After Percutaneous Transforaminal Endoscopic Discectomy Using Diffusion Tensor Imaging.

A prospective study. The aim of this study was to investigate the relationship between diffusion tensor imaging (DTI) derived parameters of compressed nerve roots at subregions and the corresponding clinical symptoms to evaluate the patients with intraspinal lumbar disc herniation (LDH)-related lumbosacral radiculopathy pre- and postoperatively. It is crucial to explore whether magnetic resonanve imaging (MRI) can quantitatively evaluate intraspinal LDH-related lumbosacral radiculopathy before and after surgery. In all, 66 patients underwent MRI scans and Clinical assessment before and after percutaneous transforaminal endoscopic discectomy (PTED). Pre- and postoperative findings of the related lumbar disk and nerve tractography were compared with two-way contingency table analysis. The embedded paired t test toolbox was applied to respectively compare the fractional anisotropy (FA) and apparent diffusion coefficient (ADC) values of nerves at the symptomatic and asymptomatic sides in three subregions pre- and postoperatively. The correlation of clinical Japanese Orthopedic Association (JOA) scores and FA/ADC values of nerves at three sub-regions was analyzed by stepwise multiple linear regression analysis. The postoperative FA values were significantly higher than the corresponding preoperative values (P < 0.001), while comparable ADC values were found. Using tractography, a notable improvement of compressed nerve was revealed after surgery (61 cases, 92.4%). Additionally, multiple linear regression analysis identified significant associations between JOA scores and FA values of the compressed nerves with the greatest effect at the proximal region. The FA values at subarticular zone can reflect the microstructural changes of the corresponding compressed nerves and well associate with clinical symptoms. Therefore, the DTI parameter FA can be considered an effective tool in clinic to quantitatively evaluate intraspinal LDH-related lumbosacral radiculopathy before and after PTED surgery.Level of Evidence: 3.

Study on Influencing Factors of Postoperative Recurrence of Lumbar Disc Herniation Treated by Percutaneous Transforaminal Endoscopic Discectomy

To investigate the influencing factors of percutaneous perforation for lumbar disc herniation. A total of 65 patients with recurrent lumbar disc herniation treated in our hospital from January 2015 to December 2020 (observation group) were selected and 130 patients without recurrence were selected as the control group. 65 patients with recurrent lumbar disc herniation were divided into Group A (n=32) and Group B (n=33). The patients in Group A were treated with percutaneous transforaminal endoscopic lumbar discectomy and the patients in Group B were treated with traditional spinal canal decompression, and nucleus pulposus removal cage fusion and internal fixation. The operation, Japanese orthopaedic association score and Oswestry disability index of the two groups were observed. Logistic regression analysis showed that age, body mass index, Pfirrman classification, incomplete removal of nucleus pulposus during operation and postoperative sedentary work or heavy physical work were the influencing factors of postoperative recurrence (Odds ratio=1.667, 1.545, 1.831, 2.038 and 1.925, p<0.05 ). The operation time, intraoperative blood loss and hospitalization time in Group A were (50.51±3.39) min, (45.51±3.15) ml and (12.03±3.22) d, respectively, which were significantly less than those in Group B (p<0.05). Japanese orthopaedic association score at 3 mo after operation in Group A was (25.51±2.03) points, which was significantly higher than that in Group B (p<0.05), while Oswestry disability index was (20.03±2.62) %, which was significantly lower than that in Group B (p<0.05). The visual analogue scale score of Group A at 3 mo after operation was (2.50±0.44) points, which was significantly lower than that of Group B (p<0.05). Patients with recurrence after percutaneous transforaminal endoscopic treatment effect are still good.

Radiological risk factors for recurrent lumbar disc herniation after percutaneous transforaminal endoscopic discectomy: a retrospective matched case-control study

To investigate radiological risk factors for recurrent lumbar disc herniation (rLDH) after percutaneous transforaminal endoscopic discectomy (PTED). Patients who underwent PTED due to a single-level L4-L5 or L5-S1 disc herniation from January 2013 to May 2019 were enrolled in this study. A matched case-control design was carried out in a single institution. Cases were defined as those who developed rLDH, and controls were matched from those patients without rLDH according to corresponding clinical characteristics. The radiological parameters were compared between two groups. The radiological risk factors for rLDH after PTED were identified by univariate and multivariate logistic regression analysis. A total of 2186 patients who underwent PTED at L4-L5 or L5-S1 level were enrolled in this study. Sixty-eight patients were diagnosed with rLDH, and 136 patients were selected from the remaining 2118 nonrecurrent patients as matched controls. Univariate analysis demonstrated that herniation type (P = 0.009), surgical-level disc degeneration (P < 0.001), adjacent-level disc degeneration (P = 0.017), disc height index (DHI) (P = 0.003), and sagittal range of motion (sROM) (P < 0.001) were significantly related to rLDH. Multiple logistic regression analysis showed that low grade of surgical-level disc degeneration (P < 0.001), senior grade of adjacent-level disc degeneration (P < 0.001), a high DHI (P = 0.012), and a large sROM (P < 0.001) were the radiological independent risk factors. This study showed that low grade of surgical-level disc degeneration, senior grade of adjacent-level disc degeneration, a high DHI, and a large sROM were the radiological independent risk factors for rLDH after PTED.

Analysis of Influencing Factors on Short-Term Efficacy of Percutaneous Transforaminal Endoscopic Lumbar Discectomy in the Treatment of Lumbar Disc Herniation

To explore the factors influencing the short-term efficacy of percutaneous transforaminal endoscopic lumbar discectomy in the treatment of lumbar disc herniation is the main objective. 100 patients with lumbar disc herniation who were treated in our hospital from February 2017 to February 2019 were selected as the control group (n=85, effective) and observation group (n=15, ineffective), the effective rate of treatment was statistically analyzed. Visual analogue scale and Japanese orthopaedic association scores were compared before surgery, 3 mo after surgery and 6 mo after surgery. The influencing factors of lumbar disc herniation treatment effect were analyzed. The effective rate of lumbar disc herniation patients treated by percutaneous transforaminal endoscopic lumbar discectomy surgery was 85.00 %. Compared with that before surgery, the visual analogue scale score of lumbar disc herniation patients was significantly decreased 3 mo after surgery and 6 mo after surgery, but the Japanese orthopaedic association score was significantly increased (p<0.05). In logistics regression analysis, it was found that the course of disease, history of trauma and degree of lumbago were the main factors affecting the therapeutic efficacy of percutaneous transforaminal endoscopic surgery in patients with lumbar disc herniation. There are many factors influencing the efficacy of percutaneous transforaminal endoscopic surgery for lumbar disc herniation patients and the relationship between them and the therapeutic effect should be comprehensively analyzed.

Percutaneous Transforaminal Endoscopic Decompression in Lumbar Discal Cyst

Background: Discal cyst is a rare pathology causing lumbar radiculopathy. Conventional open and microsurgical resection is the most commonly reported surgical treatment for discal cyst. Full-endoscopic surgeries are an efficient but sparsely reported modality. Case Presentation: This is a retrospective study that presents the outcomes of 2 patients with lumbar discal cyst (with radiculopathy in the legs and Visual Analog Scale (VAS) scores of 10 out of 10, classic clinical-radiological presentation features) who were treated with Percutaneous transforaminal endoscopic lumbar discectomy (PTELD) under local anesthesia (LA). Validated Oswestry Disability Index (ODI) and MacNab scores were used for clinical outcome assessment. Additionally, we conducted a review of the literature on full-endoscopic approaches for discal cyst, namely PTELD, percutaneous interlaminar endoscopic lumbar discectomy (PIELD), and transsacral epiduroscopic decompression (SELD). Conclusion: PTELD for lumbar discal cyst is an excellent method to yield a positive long-term out-come, and one of the most minimally invasive full-endoscopic approaches. Key words: Decompression, disc, discal cyst, full endoscopy, lumbar, stenosis, surgery, transforaminal

Body image and cosmesis after percutaneous transforaminal endoscopic discectomy versus conventional open microdiscectomy for sciatica caused by lumbar disk herniation: results of a randomized controlled trial

Body image and cosmesis after percutaneous transforaminal endoscopic discectomy versus conventional open microdiscectomy for sciatica caused by lumbar disk herniation: results of a randomized controlled trial

Comparison of Percutaneous Transforaminal Endoscopic Discectomy and Microendoscopic Discectomy for the Surgical Management of Symptomatic Lumbar Disc Herniation: A Multicenter Retrospective Cohort Study with a Minimum of 2 Years’ Follow-Up

BACKGROUND: Percutaneous transforaminal endoscopic discectomy (PTED) and microendoscopic discectomy (MED) are alternative minimally invasive procedures for the treatment of symptomatic lumbar disc herniation (LDH). However, insufficient literature exists to highlight the differences between the procedures. OBJECTIVES: This study intended to clarify whether PTED results in better clinical outcomes compared with MED in the surgical management of single-level LDH. STUDY DESIGN: A multicenter retrospective cohort study. SETTING: This study took place in 2 spinal minimally invasive centers in Beijing, China. METHODS: A multicenter retrospective study was conducted in consecutive patients diagnosed with symptomatic LDH receiving PTED or MED in 2 spinal minimally invasive centers from April 2009 to July 2016. A total of 1,053 patients were recruited, of which 632 underwent PTED and 421 underwent MED. All patients were followed with a minimum of 2 years; a set of clinical outcomes were extracted and analyzed. RESULTS: The operation time was similar between groups (71.2 ± 15.1 minutes in the PTED group and 69.4 ± 12.5 minutes in the MED group; P = 0.518); length of incision was significantly shorter; intraoperative blood loss was less in the PTED group (P &lt; 0.001); hospital stay was 3.6 ± 1.5 days in the PTED group and 5.4 ± 2.8 days in the MED group with significant differences detected (P = 0.018); however, intraoperative fluoroscopy was longer with significantly higher cost with the PTED group (P &lt; 0.001). Transient dysesthesia and wound complications were more common in the MED group (P = 0.039 and P = 0.026, respectively); however, no significant differences were found with total complications (P = 0.139). Significant lower Visual Analog Scale pain score (back and leg) were detected on day 1 postoperatively (P = 0.007 and P = 0.018, respectively). No significant differences were found at all other time points (P &gt; 0.05). Significantly better Oswestry Disability Index (ODI) score was detected postoperatively at 1 month in the PTED group (19.6 ± 9.8 vs. 27.2 ± 9.3; P = 0.016); ODI score at other time points did not differ significantly between groups (P &gt; 0.05). Modified MacNab criteria showed that most patients experienced excellent and good results with no significant differences between groups (P = 0.511). LIMITATION: This was a multicenter retrospective study wherein the surgeons may have introduced bias to the study. CONCLUSIONS: Both PTED and MED present to be an acceptable long-term efficacy for the treatment of LDH. Although PTED is associated with longer intraoperative fluoroscopy and a little more cost, it should still be considered superior to MED considering the benefits of lesser invasion, shorter hospital stays, quicker pain relief, and functional recovery. KEY WORDS: Percutaneous transforaminal endoscopic discectomy, microendoscopic discectomy, lumbar disc herniation, VAS score, ODI score

Evaluation of Percutaneous Transforaminal Endoscopic Discectomy in the Treatment of Lumbar Disc Herniation: A Retrospective Study.

ObjectiveThe objective of the present study was to evaluate the safety and efficacy of percutaneous transforaminal endoscopic discectomy (PTED) and open fenestration discectomy (OFD) in the treatment of lumbar disc herniation (LDH).MethodsPatients in our hospital with LDH who received PTED (n = 71) and OFD (n = 39) from 2013 to 2014 were retrospectively studied. Patient information, including age, gender, visual analogue scale (VAS) score for low back pain and leg pain, body weight, height, Oswestry disability index (ODI), Japanese Orthopedic Association (JOA), and recurrence, was collected. The patients in the two groups were followed up for an average of 63 months after surgery.ResultsA total of 136 patients completed the operation and 110 patients were followed up completely. There was no significant difference in baseline data between the two groups (P > 0.05). The postoperative low back pain, leg pain, ODI, and JOA of the two groups were better than those preoperatively (P < 0.05). One week after surgery, the recovery of PTED patients was better than that of OFD. The ODI score of the PTED group was lower than that of the OFD group (10 [8, 12] vs 14 [11, 16]; P < 0.05), the waist VAS score of the PTED group was lower than that of the OFD group (2 [2, 3] vs 3 [2, 4]; P < 0.05), the leg VAS score of the PTED group was lower than that of the OFD group (1 [0,1] vs 1 [1, 2]; P < 0.05), while the JOA score of the PTED group was higher than that of OFD group [19(16, 20) vs 12(10, 17); P < 0.05]. There were no significant differences in ODI, JOA, waist and leg VAS scores between the two groups at 1 month after surgery and at subsequent follow‐up (P > 0.05). At the end of the follow up, 89.7% (35/39) of patients in the OFD group had excellent improvement in the JOA score, and 88.7% (63/71) of patients in the PTED group had an excellent improvement. There was no significant difference between the two (P > 0.05). There was also no significant difference in the recurrence rate between the two groups [(5/71) vs (3/39); P > 0.05]. [Correction added on 05 March 2021, after first online publication: “3/29” was amended to “3/39” in the preceding sentence.]ConclusionBoth PTED and OFD can achieve good mid‐term efficacy in the treatment of LDH but PTED has certain advantages, including the small incision, a shorter hospital stay, and quicker, earlier recovery. However, prospective randomized controlled studies with a larger sample size are needed.