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International Orthopaedics

Published in:

01-04-2019 | Original Paper

Outcomes of percutaneous endoscopic trans-articular discectomy for huge central or paracentral lumbar disc herniation

Authors: Yu Wang, Yuqing Yan, Jin Yang, Lifeng Zhang, Chuan Guo, Zhiyu Peng, Hao Wu, Dongfeng Zhang, Qingquan Kong

Published in: International Orthopaedics | Issue 4/2019

Abstract

Purpose

This study reports a new technique known as percutaneous endoscopic trans-articular discectomy (PETAD) for huge central/paracentral lumbar disc herniation (LDH).

Methods

Sixteen patients with huge central/paracentral LDH who underwent PETAD in our department from July 2015 to July 2016 were retrospectively analyzed. Clinical outcomes were evaluated according to pre-operative and post-operative visual analog scale (VAS) and Oswestry disability index (ODI) scores and the MacNab criteria. Immediate post-operative MRI and CT were conducted to confirm complete removal of LDH along with follow-up flexion-extension X-ray to observe lumbar stability.

Results

The huge central/paracentral LDH was completely removed by PETAD in 16 patients, as confirmed by post-operative MRI and CT. Leg pain was eased after removal of the disc herniations. The satisfactory (excellent/good) results were 93.7%. The mean follow-up duration was 15.6 (range, 3–24) months. The mean pre-operative VAS and ODI scores were 5.72 ± 1.18 (range, 4–9) and 60.1 (range, 51–87), respectively, which decreased to 1.26 ± 0.81 (range, 0–3) and 18.1 (range, 10–31), respectively at the third month post-operatively and to 0.78 ± 0.62 (range, 0–1) and 7.2 (range, 0–15), respectively by the last follow-up visit. No recurrence and segmental instability was observed in any of the 16 patients during the follow-up period.

Conclusion

PETAD could be a good alternative for treatment of huge central/paracentral LDH.

Kambin P, Gellman H (1983) Percutaneous lateral discectomy of the lumbar spine: a preliminary report. Clin Orthop 174:127–132

Yeung AT (2000) The evolution of percutaneous spinal endoscopy and discectomy: state of the art. Mt Sinai J Med 67(4):327–332PubMed

Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27(7):722–731CrossRefPubMed

Hoogland T, Schubert M, Miklitz B, Ramirez A (2006) Transforaminal posterolateral endoscopic discectomy with or without the combination of a low-dose chymopapain: a prospective randomized study in 280 consecutive cases. Spine (Phila Pa 1976) 31(24):E890–E897. https://doi.org/10.1097/01.brs.0000245955.22358.3a CrossRef

Zheng C, Wu F, Cai L (2016) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral lumbar disc herniations in children. Int Orthop 40(6):1099–1102. https://doi.org/10.1007/s00264-016-3155-x CrossRefPubMed

Wang K, Hong X, Zhou BY, Bao JP, Xie XH, Wang F, Wu XT (2015) Evaluation of transforaminal endoscopic lumbar discectomy in the treatment of lumbar disc herniation. Int Orthop 39(8):1599–1604. https://doi.org/10.1007/s00264-015-2747-1 CrossRefPubMed

Lewandrowski K-U (2014) “Outside-in”; technique, clinical results, and indications with transforaminal lumbar endoscopic surgery: a retrospective study on 220 patients on applied radiographic classification of foraminal spinal stenosis. Int J Spine Surg 8:26–26. https://doi.org/10.14444/1026 CrossRefPubMedCentral

Ahn Y (2014) Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices 11(6):000–000. https://doi.org/10.1586/17434440.2014.940314 CrossRef

Sairyo K, Chikawa T, Nagamachi A (2018) State-of-the-art transforaminal percutaneous endoscopic lumbar surgery under local anesthesia: discectomy, foraminoplasty, and ventral facetectomy. J Orthop Sci 23(2):229–236. https://doi.org/10.1016/j.jos.2017.10.015 CrossRefPubMed

10.

Li ZZ, Hou SX, Shang WL, Cao Z, Zhao HL (2016) Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: technique notes and 2 years follow-up. Clin Neurol Neurosurg 143:90–94. https://doi.org/10.1016/j.clineuro.2016.02.008 CrossRefPubMed

11.

Ahn Y, Oh HK, Kim H, Lee SH, Lee HN (2014) Percutaneous endoscopic lumbar foraminotomy: an advanced surgical technique and clinical outcomes. Neurosurgery 75(2):124–133; discussion 132-123. https://doi.org/10.1227/NEU.0000000000000361 CrossRefPubMedPubMedCentral

12.

Li ZZ, Hou SX, Shang WL, Song KR, Zhao HL (2017) Modified percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar discectomy: instrument design, technique notes, and 5 years follow-up. Pain Physician 20(1):E85–E98PubMed

13.

Choi G, Lee SH, Lokhande P, Kong BJ, Shim CS, Jung B, Kim JS (2008) Percutaneous endoscopic approach for highly migrated intracanal disc herniations by foraminoplastic technique using rigid working channel endoscope. Spine (Phila Pa 1976) 33(15):E508–E515. https://doi.org/10.1097/BRS.0b013e31817bfa1a CrossRef

14.

Wang Y, Kong Q, Song Y (2017) Short-term effectiveness of accurate decompression via foraminoplasty in treatment of lumbar lateral recess stenosis. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 31(11):1334–1340. https://doi.org/10.7507/1002-1892.201705076 CrossRefPubMed

15.

Sairyo K, Higashino K, Yamashita K, Hayashi F, Wada K, Sakai T, Takata Y, Tezuka F, Morimoto M, Terai T, Chikawa T, Yonezu H, Nagamachi A, Fukui Y (2017) A new concept of transforaminal ventral facetectomy including simultaneous decompression of foraminal and lateral recess stenosis: technical considerations in a fresh cadaver model and a literature review. J Med Investig 64(1.2):1–6. https://doi.org/10.2152/jmi.64.1 CrossRef

16.

Du J, Tang X, Jing X, Li N, Wang Y, Zhang X (2016) Outcomes of percutaneous endoscopic lumbar discectomy via a translaminar approach, especially for soft, highly down-migrated lumbar disc herniation. Int Orthop 40(6):1247–1252. https://doi.org/10.1007/s00264-016-3177-4 CrossRefPubMed

17.

Li X, Dou Q, Hu S, Liu J, Kong Q, Zeng J, Song Y (2016) Treatment of cauda equina syndrome caused by lumbar disc herniation with percutaneous endoscopic lumbar discectomy. Acta Neurol Belg 116(2):185–190. https://doi.org/10.1007/s13760-015-0530-0 CrossRefPubMed

18.

Gu G, Zhang H, Fan G, He S, Cai X, Shen X, Guan X, Zhou X (2014) Comparison of minimally invasive versus open transforaminal lumbar interbody fusion in two-level degenerative lumbar disease. Int Orthop 38(4):817–824. https://doi.org/10.1007/s00264-013-2169-x CrossRefPubMed

19.

Choi JW, Lee JK, Moon KS, Hur H, Kim YS, Kim SH (2007) Transdural approach for calcified central disc herniations of the upper lumbar spine. Technical note. J Neurosurg Spine 7(3):370–374. https://doi.org/10.3171/SPI-07/09/370 CrossRefPubMed

20.

Tulloch I, Papadopoulos MC (2018) Giant central lumbar disc herniations: a case for the transdural approach. Ann R Coll Surg Engl 100(3):e53–e56. https://doi.org/10.1308/rcsann.2017.0218 CrossRefPubMedPubMedCentral

21.

Choi KC, Lee JH, Kim JS, Sabal LA, Lee S, Kim H, Lee SH (2015) Unsuccessful percutaneous endoscopic lumbar discectomy: a single-center experience of 10,228 cases. Neurosurgery 76(4):372–380; discussion 380-371; quiz 381. https://doi.org/10.1227/NEU.0000000000000628 CrossRefPubMed

22.

Lee SH, Choi KC, Baek OK, Kim HJ, Yoo SH (2014) Percutaneous endoscopic intra-annular subligamentous herniotomy for large central disc herniation: a technical case report. Spine (Phila Pa 1976) 39(7):E473–E479. https://doi.org/10.1097/BRS.0000000000000239 CrossRef

23.

Kang Q, Li X, Cheng Z, Liu C (2017) Effects of release and decompression techniques on nerve roots through percutaneous transforaminal endoscopic discectomy on patients with central lumbar disc herniation. Exp Ther Med 13(6):2927–2933. https://doi.org/10.3892/etm.2017.4293 CrossRefPubMedPubMedCentral

24.

Hua W, Tu J, Li S, Wu X, Zhang Y, Gao Y, Zeng X, Yang S, Yang C (2018) Full-endoscopic discectomy via the interlaminar approach for disc herniation at L4-L5 and L5-S1: an observational study. Medicine (Baltimore) 97(17):e0585. https://doi.org/10.1097/MD.0000000000010585 CrossRef

25.

Kondo M, Oshima Y, Inoue H, Takano Y, Inanami H, Koga H (2018) Significance and pitfalls of percutaneous endoscopic lumbar discectomy for large central lumbar disc herniation. J Spine Surg 4(1):79–85. https://doi.org/10.21037/jss.2018.03.06 CrossRefPubMedPubMedCentral

26.

Cohen SP, Raja SN (2007) Pathogenesis, diagnosis, and treatment of lumbar zygapophysial (facet) joint pain. Anesthesiology 106(3):591–614CrossRefPubMed

27.

Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33(9):931–939. https://doi.org/10.1097/BRS.0b013e31816c8af7 CrossRef

28.

Zeng Z-L, Zhu R, Wu Y-C, Zuo W, Yu Y, Wang J-J, Cheng L-M (2017) Research article effect of graded facetectomy on lumbar biomechanics. J Healthc Eng:1–6. https://doi.org/10.1155/2017/7981513

29.

Tender GC, Kutz S, Baratta R, Voorhies RM (2005) Unilateral progressive alterations in the lumbar spine: a biomechanical study. J Neurosurg Spine 2(3):298–302. https://doi.org/10.3171/spi.2005.2.3.0298 CrossRefPubMed

30.

Abumi K, Panjabi MM, Kramer KM, Duranceau J, Oxland T, Crisco JJ (1990) Biomechanical evaluation of lumbar spinal stability after graded facetectomies. Spine 15(11):1142–1147CrossRefPubMed

31.

Jaumard NV, Welch WC, Winkelstein BA (2011) Spinal facet joint biomechanics and mechanotransduction in normal, injury and degenerative conditions. J Biomech Eng 133(7):071010–071031. https://doi.org/10.1115/1.4004493 CrossRefPubMed

32.

Osman SG, Nibu K, Panjabi MM, Marsolais EB, Chaudhary R (1997) Transforaminal and posterior decompressions of the lumbar spine. A comparative study of stability and intervertebral foramen area. Spine 22(15):1690–1695CrossRefPubMed

33.

Jasper GP, Francisco GM, Telfeian AE (2013) Clinical success of transforaminal endoscopic discectomy with foraminotomy: a retrospective evaluation. Clin Neurol Neurosurg 115(10):1961–1965. https://doi.org/10.1016/j.clineuro.2013.05.033 CrossRefPubMed

34.

Hoogland T, van den Brekel-Dijkstra K, Schubert M, Miklitz B (2008) Endoscopic transforaminal discectomy for recurrent lumbar disc herniation: a prospective, cohort evaluation of 262 consecutive cases. Spine (Phila Pa 1976) 33(9):973–978. https://doi.org/10.1097/BRS.0b013e31816c8ade CrossRef

Title: Outcomes of percutaneous endoscopic trans-articular discectomy for huge central or paracentral lumbar disc herniation
Authors: Yu Wang
Yuqing Yan
Jin Yang
Lifeng Zhang
Chuan Guo
Zhiyu Peng
Hao Wu
Dongfeng Zhang
Qingquan Kong
Publication date: 01-04-2019
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 4/2019
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-018-4210-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Outcomes of percutaneous endoscopic trans-articular discectomy for huge central or paracentral lumbar disc herniation

Abstract

Purpose

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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