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Technique of Percutaneous Transforaminal Endoscopic Discectomy for the Treatment of Lumbar Disc Herniation  [PDF]
Rama Shankar Gupta, Xiao-Tao Wu, Xin Hong, Arjun Sinkemani
Open Journal of Orthopedics (OJO) , 2015, DOI: 10.4236/ojo.2015.57028
Abstract: Percutaneous Transforaminal Endoscopic Discectomy is a minimally invasive surgery with little pain, less blood loss, less hospital stay and the surgery can be done in local anesthesia, which was started during late 20th century. Kambin and Gellmann in 1973 in the United States and Hijikata in Japanin 1977 individually preformed posterolateral percutaneous nucleotomy for the resection of the nucleus pulposus and release of compressed exiting nerve root, which is now spreading through the world and many surgeons are developing their skill but it needs experience and patience for successful outcomes. Along with advanced instruments now the surgery can be performed only giving a small skin incision of 8 - 10 mm and is as effective as the conventional method of surgery and open microdiscectomy surgery for the treatment of symptomatic lumbar disc herniation. In this review, we are explaining the technique of minimally invasive Percutaneous Transforaminal Endoscopic Discectomy surgery along its advantages and complications which can be encountered while performing this technique.
The Clinical Outcomes of Transforaminal Percutaneous Endoscopic Discectomy in Treating Lumbar Disc Herniation: A Review  [PDF]
Bheemasetty Rakesh, Yun Tao Wang
Open Journal of Orthopedics (OJO) , 2018, DOI: 10.4236/ojo.2018.82008
Abstract: Percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique started during the late 20th century. This process is done through microscopic view under local anesthesia. There is a growing but still insufficient evidence that lumbar EDS shows slightly better results in terms of minor tissue damage, shorter hospital stay, faster return to ordinary daily activities, and patient satisfaction. Recurrence rate still remains a matter of debate, and is related with the surgical skills of the surgeon. The complication rate seems to be similar in both of the techniques i.e., open and endoscopic. More randomized controlled trials, systematic reviews and meta-analysis are needed to clarify whether lumbar EDS can be considered comparable if not superior to standard open discectomy. In spite of lacking defined clinical evidence, lumbar EDS is without doubt a rapidly expanding PELD and its future developments are incredibly promising. Due to less complication rate this technique can be considered as a gold standard compared to the open discectomy. The surgeons still require more cadaveric practices for learning the curve and to approach the herniated disc area. The main objective of this review article is to show the clinical outcomes of the Transforaminal Percutaneous Endoscopic Discectomy in treating the lumbar disc herniation.
Clinical Outcome of Percutaneous Endoscopic Lumbar Surgery (PELS) in Treatment of Lumbar Disc Herniation  [PDF]
Mangal P. Hirachan, Zengxin Gao, Yucheng Lin, Ratish Singh
Open Journal of Orthopedics (OJO) , 2017, DOI: 10.4236/ojo.2017.74012
Abstract: Lumbar disc herniation is a spinal problem seen in both young and old people causing pain in the back with pain and numbness in lower extremity leading to disability limiting daily activities. When conservative treatments are ineffective, then it is treated by surgeries, more recently with minimal invasive percutaneous endoscopic lumbar surgery (PELS). One of the mostly accepted PELS by spinal surgeons is percutaneous transforaminal endoscopic lumbar discectomy, which can be performed for any age. The main aim of this review was to evaluate clinical outcome and safety based on the Oswestry Disable Index (ODI), Visual Analog Scale (VAS) and MacNab criteria and complications of PELS surgery and its advantages in clinical basis.
Endoscopic Transforaminal Thoracic Foraminotomy and Discectomy for the Treatment of Thoracic Disc Herniation  [PDF]
Hong-Fei Nie,Kai-Xuan Liu
Minimally Invasive Surgery , 2013, DOI: 10.1155/2013/264105
Abstract: Thoracic disc herniation is a relatively rare yet challenging-to-diagnose condition. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Previously reported surgical approaches are often associated with high complication rates. Here we describe our minimally invasive technique of removing thoracic disc herniation, and report the primary results of a series of cases. Between January 2009 and March 2012, 13 patients with symptomatic thoracic disc herniation were treated with endoscopic thoracic foraminotomy and discectomy under local anesthesia. A bone shaver was used to undercut the facet and rib head for foraminotomy. Discectomy was achieved by using grasper, radiofrequency, and the Holmium-YAG laser. We analyzed the clinical outcomes of the patients using the visual analogue scale (VAS), MacNab classification, and Oswestry disability index (ODI). At the final follow up (mean: 17 months; range: 6–41 months), patient self-reported satisfactory rate was 76.9%. The mean VAS for mid back pain was improved from 9.1 to 4.2, and the mean ODI was improved from 61.0 to 43.8. One complication of postoperative spinal headache occurred during the surgery and the patient was successfully treated with epidural blood patch. No other complications were observed or reported during and after the surgery. 1. Introduction Thoracic disc herniation is an uncommon condition. Although conservative treatment works well for many patients with thoracic disc herniation, surgical treatment is needed for patients suffering from myelopathy and/or neurological deficit caused by thoracic disc herniation. In the past decade, quite a few surgical procedures have been reported in the literature, and each of them has its own advantages and disadvantages [1–14]. Currently there is no universally accepted optimal surgical treatment for symptomatic thoracic disc herniation. Minimally invasive spine surgery has proven safe and effective in treating lumbar and cervical herniations [15–24]. The advantages of minimally invasive techniques have compelled many physicians to explore the feasibility of using minimally invasive techniques in treating thoracic disc herniation, and a number of authors have reported encouraging primary results [14, 25–28]. Based on our extensive experience with treating lumbar and cervical disc herniation using minimally invasive techniques, we have developed an endoscopic transforaminal foraminotomy and discectomy technique for treating thoracic disc herniation. The purposes of this paper are to describe the

- , 2015, DOI: 10.7507/1002-1892.20150011
Abstract: 目的评价经皮内镜椎间孔入路微创治疗复发性腰椎间盘突出症的可行性和有效性。 方法2009年6月-2011年12月,采用经皮内镜椎间孔入路腰椎间盘髓核摘除术治疗复发性腰椎间盘突出症患者56例,其中男30例,女26例;年龄24~70岁,平均50岁。突出节段:L3、4 3例,L4、5 34例,L5~S1 19例。与初次手术同侧突出48例,对侧突出8例。无症状间歇期6个月~27年,平均5.5年。术前采用疼痛视觉模拟评分(visual analogue scale,VAS)评分:腰痛(6.18±1.44)分,腿痛(7.66±1.03)分。患者均在局麻下完成手术,术后随访患者症状改善情况,采用VAS评分、改良MacNab标准评估临床疗效。 结果手术时间30~100min,平均60.4min;住院时间3~6d,平均5.1d。患者均获随访,随访时间24~56个月,平均28.2个月。患者术后即刻疼痛均有不同程度缓解,术后1、3、12个月及末次随访时腰痛及腿痛VAS评分均较术前明显下降,差异有统计学意义( P<0.05)。术后12个月,采用改良MacNab标准评价疗效,获优39例,良9例,可5例,差3例,优良率85.7%。5例(8.9%)术后发生手术相关并发症;1例(1.8%)术后18个月再次复发,行相应节段减压及椎间融合术后症状缓解。 结论经皮内镜椎间孔入路腰椎间盘髓核摘除术可以避开后方瘢痕组织,降低了手术相关并发症的发生率,且创伤小,手术时间短,恢复快,是微创治疗复发性腰椎间盘突出症的有效方法。
ObjectiveTo determine the feasibility and effectiveness of percutaneous endoscopic transforaminal discectomy (PETD) for recurrent lumbar disc herniation (RLDH). MethodsBetween June 2009 and December 2011, 56 patients with RLDH underwent PETD after local anesthesia, including 30 males and 26 females, with a mean age of 50 years (range, 24-70 years). The involved segments were L3, 4 in 3 cases, L4, 5 in 34 cases, and L5-S1 in 19 cases. Of 56 patients, 48 suffered from ipsilateral re-herniation, and 8 suffered from contralateral re-herniation. All the patients had a mean pain-free interval of 5.5 years (range, 6 months to 27 years). The visual analogue scale (VAS) score for back pain was 6.18±1.44 and the VAS score for leg pain was 7.66±1.03. Postoperative effectiveness was assessed based on the VAS score and modified MacNab criteria. ResultsThe mean operation time was 60.4 minutes (range, 30-100 minutes) and the mean duration of hospital stay was 5.1 days (range, 3-6 days). All patients were followed up 28.2 months on average (range, 24-56 months). Patients obtained immediate pain relief postoperatively. The postoperative VAS scores of back and leg pain at 1 month, 3 months, 12 months, and last follow-up were significantly decreased when compared with preoperative score ( P<0.05). Based on the modified MacNab criteria, the results were excellent in 39 cases, good in 9 cases, fair in 5 cases, and poor in 3 cases at 12 months after operation, and the excellent and good rate was 85.7%. Surgery-related complications were found in 5 cases (8.9%); one patient (1.8%) suffered from recurrence at 18 months postoperatively, and the symptom was relieved after open lumbar discectomy and intervertebral fusion surgery. ConclusionPETD has several advantages in treating RLDH, such as avoiding from the old scar tissue, decreasing operation-related complications, shortening operation time, reducing trauma, and obtaining
TLIF: transforaminal lumbar interbody fusion
Figueiredo, Nicandro;Martins, Johnny Wesley G.;Arruda, Alfredo A.;Serra, Alexandre R.;Figueiredo, Marco Ant?nio A.;Diniz, Rodrigo C.;Cavicchioli, Alessandro A.;
Arquivos de Neuro-Psiquiatria , 2004, DOI: 10.1590/S0004-282X2004000500014
Abstract: transforaminal lumbar interbody fusion (tlif) is a relatively new technique of lumbar arthrodesis via posterior transforaminal approach to the disc, indicated mainly in cases of degenerative disc disease, low grade spondylolisthesis and reoperation for disc herniation, specially when there is indication for interbody fusion and posterior decompression. the main advantage of tlif is that it allows the complete removal of the intervertebral disc through the vertebral foramen, decompression of the spinal canal and vertebral foramen with minimum risk of neural lesion, due to the access being lateral to the nerve roots. in this study, we describe the first 24 cases of tlif that we have done, wich shows to be very safe and efficient in our serie, with an relief of pain in 83.3% of patients, great improvements in the life quality in 75% of cases and satisfaction with the surgery in 79.1% of patients.
Transforaminal Endoscopic Discectomy in Lumbar Disc Herniations
Hakan ILASLAN,Ahmet ASLAN,Omer Nadir KOC,Turker DALKILIC
Journal of Neurological Sciences , 2010,
Abstract: Objective Endoscopic lumbar discectomy has been popular in recent years. Currently transforaminal endoscopic discectomy is performed successfully in selected cases. The aim of this study is to review the preliminary results of transforaminal endoscopic discectomy procedure.Methods The charts of cases who underwent transforaminal endoscopic discectomy in 2008-2009 were reviewed retrospectively. The demographic data, the preoperative and postoperative pain severity (based on VAS scores), and postoperative 1 and 6th month satisfaction rates (based on Macnab classification) were analysed.Results There were 21 cases (13 male, and 8 female). The main symptom was sciatica. There was motor deficit in three cases. The preoperative mean VAS score was 8.47. The disc herniation was located in L3-4 in four cases, in L4-5 in 15 cases, and in L5-S1 in two cases. The lumbar disc herniation was foraminal or foraminal + paramedian in 17 cases, and extraforaminal (far lateral) in 4 cases. Eighteen cases (85%) was satisfied from the procedure in early postoperative period, and the mean VAS score reduced to 2.1. Three out of 18 cases who were well in early postoperative period reported light sciatica and suffered transforaminal selective nevre root block. The satisfaction rate reduced to 71% in 6th month postoperatively. The VAS sacore was reported to be 2.4 at 6th month.Conclusion Transforaminal endoscopic discectomy was found to be successful and safe in selected cases. However, cooperation with patient during the surgery, the height of disc, the location of disc, and the experience of the surgeon affect the success rate after the surgery.
Avalia??o clínica radiológica da artrodese lombar transforaminal aberta versus minimamente invasiva
Menezes, Cristiano Magalh?es;Falcon, Roberto Sakamoto;Ferreira Júnior, Marcos Ant?nio;Alencar, Johmeson;
Coluna/Columna , 2009, DOI: 10.1590/S1808-18512009000300010
Abstract: objective: the aim of this article is to compare the clinical and radiological results of patients who underwent open and minimally invasive transforaminal lumbar interbody fusion. methods: forty-five patients underwent transforaminal lumbar interbody fusion by the department of spine surgery of hospital lifecenter/ortopédico, between december 2005 and may 2007, 15 of them were in the open interbody fusion group, and 30 in the minimally invasive one. the indications were: the degenerative disc disease associated or not with discal herniation or stenosis; low grade lythic or degenerative spondylolisthesis and post-discectomy/laminectomy syndrome. the variables analyzed were operative time, length of hospital stay, need for blood transfusion, visual analogical pain scale (vas), oswestry functional disability index, solid fusion and return to work. results: the minimum follow-up was two years. there were eight men and seven women in the open group, and 17 men and 13 women in the mis group. the mean operative time was 222 minutes and 221 minutes, respectively. there was improvement on the vas and oswestry scores in both groups. the mean hospital stay was 3.3 days for open, and 1.8 days for the mis group. the fusion rate obtained was 93.3% in both groups. blood transfusion was necessary for three patients (20%) of the open group. conclusions: the mis tlif has similar results to open tlif in two years follow-up, with additional benefits of less postoperative morbidity, shorter hospital stay and sooner rehabilitation.
Effect of Age and Lordotic Angle on the Level of Lumbar Disc Herniation  [PDF]
Ghassan S. Skaf,Chakib M. Ayoub,Nathalie T. Domloj,Massud J. Turbay,Cherine El-Zein,Mukbil H. Hourani
Advances in Orthopedics , 2011, DOI: 10.4061/2011/950576
Abstract: It has been previously suggested in the literature that with aging, degenerative changes as well as disc herniation start at the lower lumbar segments, with higher disc involvement observed in an ascending fashion in older age groups. We conducted a study to investigate this correlation between age and level of disc herniation, and to associate it with the magnitude of the Lumbar Lordotic Angle (LLA), as measured by Cobb’s method. We followed retrospectively lumbosacral spine MRI’s of 1419 patients with symptomatic disc herniation. Pearson’s correlation was used in order to investigate the relationship between LLA, age, and level of disc herniation. Student’s -test was applied to assess gender differences. Young patients were found to have higher LLA ( , ) and lower levels of disc herniation ( , ), whereas older patients had higher level herniation in lower LLA group (mean LLA?28.6° and 25.4°) and lower level herniation in high LLA group (mean LLA?33.2°). We concluded that Lumbar lordotic Cobb’s angle and age can be predictors of the level of lumbar disc herniation. This did not differ among men and women ( , ). 1. Introduction The mechanical properties of the intervertebral discs, as well as the interplay between the vertebral spine curvature and the ligaments and musculature that maintain it, not only impart a resilience that is important in protecting the vertebral column against compressive forces encountered in various postures [1], but largely determine the changes induced by aging, which are subsequently associated with degeneration [2], tropism [3, 4], disc herniation [5], and lordosis [6]. These variations are level [7] as well as gender specific [8]. Published morphometric studies suggest that lumbar disc herniation is more cranially localized with age [5], and this finding is as well a mirror spread of degenerative changes [9] which start earlier at the lower lumbar levels [10]. The vertebral spine presents regional curves on sagittal plane, designed to absorb impact, reduce its longitudinal stiffness, and intensify muscular function; nevertheless, it has been noted that some cases of low back pain and sciatica are attributable to abnormal alterations of the curve [11]. Lumbar lordosis is defined as the curvature assumed by the intact lumbar spine to compensate for the inclination of the sacrum, restore an upward spinal orientation, and consequently avoid a forward inclination. Its measure, as proven by multiple investigators, is influenced by various parameters, including age, gender, pelvic bend, and thoracic curvature, among others [7, 8].
The Research Progress of Percutanous Endoscopic Lumbar Discectomy Treating Lumbar Vertebrae Disease

王星宇, 谢水华, 骆云鹏
Medical Diagnosis (MD) , 2016, DOI: 10.12677/MD.2016.62009
Abstract: 经皮椎间孔镜技术属于微创技术,具有创伤小、出血少、术后恢复快、术后并发症少、对脊柱稳定性影响小等优点。最初用来治疗的疾病为腰椎间盘突出症(Lumbar Disc Herniation, LDH),即经皮椎间孔镜腰椎间盘切除术(Percutaneous Endoscopic Lumbar Discectomy, PELD)。腰椎间盘突出症是骨伤科的常见病、多发病,大部分通过保守治疗可以达到临床治愈,但保守治疗无效者需要手术治疗。传统手术治疗该病创伤大、出血多、术后恢复慢,随着微创技术的发展,经皮椎间孔镜椎间盘切除术越来越受到脊柱外科医生的青睐。此技术的应用范围也从腰椎间盘突出症扩展到腰椎不稳、椎间盘源性腰痛、腰椎管狭窄等疾病。本文将就此技术的发展概况、麻醉方法、运用范围与临床疗效作一综述。
Percutaneous Endoscopic Lumbar Discectomy (PELD) technique belongs to minimally invasive technique with the advantages of minimal trauma, less bleeding, rapid postoperative recovery, fewer complications and little affection on the spine stability. It is originally used to treat lumbar discherniation, namely percutaneous endoscopic lumbar discectomy. Lumbardisc herniation is a common disease and most of them can be treated through conservative treatment to achieve clinical cure results. But if the conservative treatment is ineffective, the patients require operative treatment. However, traditional surgical treatment has the features of large trauma, more bleeding and slow postoperative recovery. With the development of minimally invasive techniques, spine surgeons pay much attention to Percutaneous Endoscopic Lumbar Discectomy (PELD) technique. Furthermore, the indications of this technique also extend stolumbar spine instability, discogenic low back pain, lumbar spinal stenosis and other diseases. This paper will summarize the development, anesthesia, indications and clinical efficacy of this technique.
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