Tag: Percutaneous endoscopic lumbar discectomy

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Minimally Invasive Transforaminal Lumbar Interbody Fusion Versus Percutaneous Endoscopic Lumbar Discectomy: Revision Surgery for Recurrent Herniation After Microendoscopic Discectomy

WORLD NEUROSURGERY 99: 89-95, 2017

Most patients with recurrence of microendoscopic discectomy (MED) need to receive revision surgery. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous endoscopic lumbar discectomy (PELD) are common operative methods for MED recurrence, but no study has been made to compare the clinical outcomes of these 2 surgical methods as revision surgery for MED recurrence.

METHODS: A total of 105 patients who underwent either MIS-TLIF (58 patients) or PELD (47 patients) for revision of MED recurrence were included in this study. Perioperative outcomes (operation time, blood loss, and hospital stay), total cost, pain and functional scores (visual analog scale, Oswestry Disability Index, 12-item short form health survey) with a 12-month follow-up visit and review of complications and recurrence within 12 months postoperatively were recorded and assessed.

RESULTS: No significant difference of clinical outcome over time was observed between these 2 approaches. Compared with MIS-TLIF, PELD was associated with greater satisfaction in the early stage after surgery; this effect was equalized after 3 months postoperatively. PELD brought advantages in terms of shorter operation time, shorter hospital stay, less blood loss, and lower total cost compared with MIS-TLIF; however, PELD was also associated with a higher recurrence rate than MIS-TLIF.

CONCLUSIONS: Neither of these 2 surgical methods gave a clear advantage in long-term pain or function scores. Compared with MIS-TLIF, PELD could lead to a better perioperative result and less cost; however, the higher recurrence rate could not be ignored. Taking these characteristics into consideration was instrumental in pursuing personalized treatment for MED recurrence.

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Unsuccessful Percutaneous Endoscopic Lumbar Discectomy: A Single-Center Experience of 10 228 Cases

Unsuccessful Percutaneous Endoscopic Lumbar Discectomy- A Single-Center Experience of 10 228 Cases

Neurosurgery 76:372–381, 2015

Percutaneous endoscopic lumbar discectomy (PELD) has remarkably evolved with successful results. Although PELD has gained popularity for the treatment of herniated disc (HD), the risk of surgical failure may be a major obstacle to performing PELD. We analyzed unsuccessful cases requiring reoperation.

OBJECTIVE: To find common causes of surgical failure and elucidate the limitations of the conventional PELD technique.

METHODS: A retrospective review was performed on all patients who had undergone PELD between January 2001 and December 2012. Unsuccessful PELD was defined as a case requiring reoperation within 6 weeks after primary surgery. Chart review was done, and preoperative, intraoperative, and postoperative radiographic reviews were performed. All unsuccessful PELD cases were classified according to the type of HD, location of herniation, extruded disc migration, working channel position, and intraoperative and postoperative findings.

RESULTS: In 12 years, 10 228 patients had undergone PELD; 436 (4.3%) cases were unsuccessful. The causes were incomplete removal of HDs in 283 patients (2.8%), recurrence in 78 (0.8%), persistent pain even after complete HD removal in 41 (0.4%), and approach-related pain in 21 (0.2%). Incomplete removal of the HD was caused by inappropriate positioning (95 cases; 33.6%) of the working channel and occurred in central HDs (91 cases; 32.2%), migrated HDs (70 cases; 24.7%), and axillary type HDs (63 cases; 22.3%).

CONCLUSION: Proper surgical indications and good working channel position are important for successful PELD. PELD techniques should be specifically designed to remove the disc fragments in various types of HD.

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Percutaneous endoscopic treatment of foraminal and extraforaminal disc herniation at the L5-S1 level

Acta Neurochir (2012) 154:1789–1795

Microsurgery of foraminal and extraforaminal disc herniation at the L5-S1 level remains a challenge because of the limited access by a high iliac crest, the sacral ala, large transverse processes of L5 and hidden disc fragments lateral to the zygapophyseal joint.

Our aim was to present the outcome of percutaneous endoscopic lumbar discectomy (PELD) of these lateral and far lateral disc herniations at the L5-S1 level using the newly described foraminal retreat technique in a group of patients with similar preoperative diagnostic studies.

Methods A total of 22 patients, 13 males and 9 females, with foraminal and extraforaminal lumbar disc herniation at the L5-S1 level were treated by applying the PELD between September 2004 and April 2010. The clinical findings and MRI were the main diagnostic methods. Preoperative evaluation was performed with clinical examinations, the Visual Analog Pain Scale (VAS) and Oswestry Low Back Disability Index (ODI).

Findings According to the Macnab criteria, overall excellent or good outcomes were obtained in 18 patients (81.8 %), fair outcomes in 3 patients (13.6 %) and a poor outcome in 1 patient (4.5 %) at the last follow-up. The mean ODI was 67.3±19.4 preoperatively and 26.7±23.4 postoperatively. Preoperative VAS was 88.6±7.6 and 28.6±22.8 at 2 days, 40.5±22.8 at 3 weeks, 34.3±25.1 at 6-months and 32 at the last follow-up. At follow-up, two patients (9.1 %) had recurrent disc herniations that were corrected with open surgery. At the time of surgery, 16 patients held jobs. Fifteen (15) patients (93.8 %) returned to their original jobs postoperatively; one patient could not return to his original job postoperatively because of a comorbidity.

Conclusions Percutaneous endoscopic discectomy using the foraminal retreat technique is an effective treatment method for patients with foraminal and extraforaminal disc herniations at the L5-S1 level on appropriately selected patients.

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