OBJECTIVE: To explore clinical efficacy of percutaneous endoscopic discectomy with a lateral approach and dual-channel method in treating highly free lumbar disc herniation(LDH). METHODS: A retrospective analysis was conducted on 54 patients with highly free LDH who were treated with spinal endoscopic techniques from January 2021 to December 2022. Twenty-seven patients were treated with lateral approach dual-channel(lateral approach dual-channel group), including 16 males and 11 females, with an average age of (54.6±10.5) years old. Twenty-seven patients were treated with unilateral biportal endoscopic (UBE group), including 17 males and 10 females, with an average age of (52.9±12.3) years old. The number of intraoperative fluoroscopy, operation time and hospital stay, as well as visual analogue scale (VAS) and Oswestry diability index (ODI) of low back and leg pain between two patients before operation, 1 day, 1, 3, and 12 months after operation, and the efficacy was evaluated by the modified MacNab criteria at 12 mohths after operation. RESULTS: All patients were successfully completed surgical and were followed up, the time raged from 12 to 22 months with an average of (13.57±4.12) months. There was no statistically significant difference in operation time between two groups (P>0.05). The hospital stay of lateral approach dual-channel group was (3.9±1.1) days, which was shorter than that of UBE group (6.5±1.4) days, the number of intraoperative fluoroscopy in lateral approach dual-channel group was (12.7±2.1) times, which was more than that in UBE group (6.6±1.3) times, the differences were statistically significant (t=5.197, -7.532;P<0.05). VAS and ODI for low back pain at 1 day and 1 month after operation, and VAS for leg pain at 1 day after operation of lateral approach dual-channel group were superior to those of UBE group, and the differences were statistically significant (P<0.05). However, there were no statistically significant differences in VAS and ODI for low back and leg pain between two groups before operation and 3 and 12 months after operation (P>0.05). VAS and ODI of low back and leg pain were significantly improved at each time point before and after operation in both groups, and the difference were statistically significant (P<0.05). At 12 months after operation, according to the modified MacNab criteria, the excellent and good rates of therapeutic effects between lateral approach dual-channel group and UBE group were 92.6% (25/27) and 88.9% (24/27), respectively, and the difference was not statistically significant (χ²=0.22, P>0.05). CONCLUSION For patients with highly free lumbar intervertebral disc protrusion, both of lateral approach dual-channel method and UBE endoscopic surgery are safe and effective. Endoscopic surgery with lateral approach and dual-channel method could be performed under local anesthesia, allowing for the removal of the nucleus pulposus under direct vision. It is simpler, more efficient.
Humans ; Male ; Female ; Intervertebral Disc Displacement/surgery* ; Middle Aged ; Diskectomy, Percutaneous/methods* ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Adult ; Retrospective Studies ; Aged

OBJECTIVE: To compare the clinical efficacy of unilateral biportal endoscopic discectomy(UBE) and percutaneous interlaminar endoscopic discectomy(PIED) in the treatment of highly migrated lumbar disc herniation (LDH). METHODS: A retrospective analysis was conducted on 43 patients with highly migrated LDH who underwent spinal endoscopic surgery between January 2022 and December 2023. In the UBE group 22 patients included 8 males and 14 females, aged 49 to 59 years old with a mean of (54.13±2.07) years old. In the PIED group 21 patients included 11 males and 10 females, aged 49 to 59 years old with a mean of (55.04±2.80) years old. Perioperative parameters including intraoperative blood loss, operative time, and fluoroscopic exposures were compared between groups. Clinical outcomes were assessed using the visual analogue scale (VAS) for pain, Oswestry disability index (ODI), and modified MacNab criteria. Complications during the perioperative period and follow-up were recorded. RESULTS: In the PIED group, there were 3 cases of nerve injury, 1 case of residual nucleus pulposus, and 1 case of dural injury. In the UBE group, there was 1 case of nerve injury and 1 case of cerebrospinal fluid leakage. No infections or major bleeding occurred in either group. All patients completed surgery and were followed up for at least 12 months. The UBE group had significantly more intraoperative blood loss (39.09±6.10) ml and more fluoroscopic exposures (6.45±0.26) than the PIED group (34.05±5.62) ml and (3.24±0.28) with significant difference (P<0.05). Preoperative VAS and ODI showed no significant differences between two groups (P>0.05). Both groups demonstrated significant improvements in VAS and ODI postoperatively (P<0.001). At the 3rd days postoperatively, the UBE group had a significantly lower leg pain VAS (2.27±0.20) than the PIED gruop(2.95±0.24) with significant difference (P<0.05), but no significant differences were observed at the first or 12th months (P>0.05). No significant differences in ODI were found between two groups during follow-up (P>0.05). At the 1st month postoperatively, according to modified MacNab criteria, 15 patients got excellent results, 4 good, and 2 fair in PIED group;and 18 patients got excellent results, 2 good, and 2 fair in UBE group, with no significant difference between two groups(P>0.05). CONCLUSION Both PIED and UBE are effective surgical methods for treating highly migrated LDH. Compared with PIED, UBE involves slightly longer operative time, more blood loss, and more fluoroscopic exposures, but carries a lower risk of nerve injury.
Humans ; Male ; Female ; Middle Aged ; Intervertebral Disc Displacement/surgery* ; Endoscopy/methods* ; Lumbar Vertebrae/surgery* ; Retrospective Studies ; Diskectomy, Percutaneous/methods* ; Treatment Outcome

OBJECTIVE: To explore feasibility, clinical and imaging outcomes of percutaneous endoscopic interlaminar discectomy (PEID) for single level large lumbar disc herniation(LDH). METHODS: From October 2018 to March 2023, 31 patients with single level LDH treated with PEID were retrospectively analyzed. Among patients, including 18 males and 13 females, aged from 15 to 40 years old with an average of (28.5±7.4) years old;L_4,5 in 10 patients, L₅S₁ in 21 patients;14 patients on the left side, 17 patients on the right side;the courses of disease ranged from 3 to 19 months with an average of (6.8 ± 3.1) months. Operation time, blood loss, fluoroscopy times and hospital stay were observed. Visual analogue scale (VAS) was used to evaluate low back and leg pain, Oswestry disability index (ODI) was used to evaluate lumbar function, modified MacNab was used to evaluate clinical efficacy at the latest follow-up. Median sagittal diameter of spinal canal, effective sagittal diameter of spinal canal, spinal canal area, and dural sac area were used to evaluate spinal decompression. Anterior, middle, and posterior heights of intervertebral space were used to evaluate intervertebral space changes. RESULTS: All patients were performed spinal endoscopic surgery, operation time ranged from 30 to 71 min with an average of (48.7±14.2) min, blood loss ranged from 10 to 40 ml with an average of (21.1±7.0) ml, and intraoperative fluoroscopy times ranged from 4 to 7 with an average of (4.7±0.7). The hospital stay ranged from 3 to 8 days with an average of (5.1±1.3) days, and postoperative follow-up ranged from 12 to 34 months with an average of (16.9±4.1) months. VAS of low back pain before operation and 3, 6 months after operation, the latest follow-up were (6.2±1.8), (1.4±0.8), (1.9±0.7), (1.6±0.6), respectively;VAS of leg pain were (7.6±1.6), (1.8±0.9), (1.6±0.6), (1.4±0.7), respectively;ODI were (35.74±4.62), (6.68±1.78), (6.90±1.85), (7.10±1.94), respectively;postoperative lower back pain and leg pain VAS and ODI were significantly improved at all time points after operation (P<0.05). Postoperative VAS of low back pain at 6 months was higher than that of 3 months after operation (P<0.05). At the laest follow-up, 14 patients were excellent, 15 good, and 2 acceptable according to modified MacNab standard. Median diameters of spinal canal were (0.77±0.18) and (1.18±0.24) cm before operation and at the latest follow-up. The effective diameters of spinal canal were (0.48±0.17) and (0.89±0.23) cm, respectively. The vertebral canal areas were (0.90±0.22) and (1.68±0.43) cm², respectively. Dural sac areas were (0.41±0.10) and (0.81±0.24) cm², respectively. At the least follow-up, median diameter, effective diameter, area of spinal canal and dural sac were significantly increased compared with those before operation (P<0.05). Anterior vertebral space height before operation was (1.13±0.13) cm, and improved to (0.83±0.11) cm at the latest follow-up. Central height decreased from (0.81±0.20) cm before operation to (0.61±0.14) cm at the latest follow-up. The height of posterior margin decreased from (0.67±0.21) cm before operation to (0.46±0.15) cm at the latest follow-up (P<0.05). CONCLUSION PEID for giant LDH could effectively remove protruding giant nucleus pulposus tissue, and avoid injury to cauda equina nerve and nerve roots, which has good early clinical effect. However, the height of intervertebral space was obviously lost after operation.
Humans ; Male ; Female ; Adult ; Intervertebral Disc Displacement/surgery* ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Young Adult ; Adolescent ; Diskectomy, Percutaneous/methods* ; Retrospective Studies ; Nucleus Pulposus/surgery*

OBJECTIVE: To compare the clinical efficacy of full endoscopic lamina fenestration discectomy (Endo-LOVE) with full endoscopic transforaminal approach discectomy in the treatment of degenerative lumbar lateral recess stenosis. METHODS: A retrospective analysis of 48 patients with degenerative lumbar lateral recess stenosis between March 2018 and March 2019 was performed. There were 32 males and 16 females, aged from 60 to 83 years old with an average of (72.9±6.5) years, course of disease ranged from 5 to 16 years with an average of (8.0±2.8) years. The patients were divided into observation group and control group according to surgical approaches. There were 28 cases in observation group, underwent Endo-LOVE surgery;and 20 cases in control group, underwent full endoscopic foraminal approach discectomy. The operation time, intraoperative blood loss, hospitalization day and complications were observed between two groups. Visual analgue scale (VAS), Japanese Orthopaedic Association(JOA), Oswestry Disability Index(ODI), lateral crypt angle were compared between two groups. And clinical effects were evaluated by modified Macnab standard. RESULTS: There was no significant difference in follow-up and operation time between two groups (P>0.05). Intraoperative blood loss was from 5 to 15 ml with an average of (8.4±3.6) ml in observation group and 5 to 25 ml with an average of (11.5±5.4) ml in control group. The hospitalization day was from 5 to 8 days with an average of (6.0±1.0) days in observation group and 6 to 9 days with an average (7.2±1.1) days in control group. Intraoperative blood loss and hospitalization day were significantly lower in observation group(P<0.05). There were no serious complications in both groups. The VAS, JOA scores, and ODI at 3-month and final follow-up were significantly improved in both groups (P<0.05), and observation group was significantly better than control group (P<0.05). The skeletal lateral crypt angle and soft lateral crypt angle were significantly greater than the preoperative angle at 3 days postoperatively(P<0.05), and observation group was significantly better than control group(P<0.05). At the final follow-up, the modified Macnab criteria was used to assess clinical efficacy, in observation group, 22 patients obtained excellent results, 5 good and 1 fair;while 11 excellent, 4 good and 5 fair in control group;the clinical efficacy of observation group was significantly better than that of control group(P<0.05). CONCLUSION Both surgical methods are performed under direct vision, with high safety and good clinical efficacy. However, Endo-LOVE enlarged the lateral crypt more fully.
Male ; Female ; Humans ; Child, Preschool ; Child ; Adolescent ; Retrospective Studies ; Blood Loss, Surgical ; Constriction, Pathologic/surgery* ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Diskectomy/methods* ; Treatment Outcome ; Spinal Stenosis/surgery* ; Intervertebral Disc Displacement/surgery* ; Diskectomy, Percutaneous/methods*

OBJECTIVE: To compare the clinical efficacy between visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy (VPTED) and traditional percutaneous transforaminal endoscopic discectomy(PTED) in the treatment of lumbar disc herniation. METHODS: The clinical data of 60 patients with lumbar disc herniation admitted from June 2019 to December, 2020 was retrospectively analyzed. There were 38 males and 22 females, aged from 26 to 58 years old with an average of (43.63±8.48) years, 47 cases were on L_4,5 segment and 13 cases were on L₅S₁ segment. Among them, 32 were treated with VPTED (group A) and 28 were treated with traditional PTED (group B). The general conditions of all the patients were recorded, including intraoperative fluoroscopy times, operation time, hospital stay and surgical complications during follow-up. The arthroplasty area ratio was observed by sagittal CT at the middle level of the intervertebral foramen. Visual analogue scale (VAS) and Japanese Orthopaedic Association (JOA) score of low back pain, Oswestry disability index (ODI) were used to evaluate the clinical efficacy between two groups. RESULTS: All patients were followed up from 9 to 15 months with an average of (12.10±1.16) months. There was no statistical difference of preoperative general data between two groups. The operation time, fluoroscopy times and hospital stay were (70.47±5.87) min, (13.66±1.34) times and (6.31±0.69) d in group A, and (90.71±7.66) min, (22.82±2.48) times and (6.54±0.92) d in group B. The operation time and intraoperative fluoroscopy times in group A were lower than those in group B(P<0.05). There was no significant difference in hospital stay between two groups (P>0.05). No obvious surgical complications were found during the follow-up in both groups. The arthroplasty area ratio in group A was (29.72±2.84)% and (29.57±2.20)% in group B, respectively, with no significant difference (P>0.05). There was no significant difference in VAS, ODI and JOA score between two groups before operation and at the final follow-up(P>0.05), but the final follow-up was significantly improved(P<0.05). CONCLUSION The two surgical methods have definite clinical efficacy in the treatment of lumbar disc herniation. Visual trephine arthroplasty assisted percutaneous transforaminal endoscopic discectomy has the advantages of high efficiency and rapidity when establishing the channel, and can significantly reduce the operation time and intraoperative fluoroscopy times.
Male ; Female ; Humans ; Adult ; Middle Aged ; Intervertebral Disc Displacement/surgery* ; Retrospective Studies ; Lumbar Vertebrae/surgery* ; Endoscopy/methods* ; Diskectomy, Percutaneous/methods* ; Diskectomy/methods* ; Treatment Outcome ; Arthroplasty

OBJECTIVE: To observe clinical efficacy of percutaneous endoscopic transforaminal discectomy (PETD) and target radioffrequency thermal coblation nucleoplasty(CN) on inclusive lumbar disc herniation(LDH) in different age groups, and provide a basis for clinical formulation of precise and individualized treatments. METHODS: A retrospective analysis of 219 patients with lumbar disc herniation treated with PETD and CN between January 2018 and June 2021 was performed, in which 107 patients were treated with PETD and 112 with CN. Patients were stratified by age into young group(≤45 years old), middle-aged group(>45 years old and <60 years old) and older group(≥60 years old). Before treatment, 3 days, 1 month and 6 months after treatment, visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, infrared thermal imaging temperature difference (△T) and lumbar range of motion (ROM) were evaluated and clinical efficacy were compared in the different age groups between two treatment methods. RESULTS: ①VAS and JOA score outcomes, in the same age group and the same treatment method, the VAS and JOA scores at different time points postoperatively were obviously improved (P<0.05). For the same age group and the different treatment methods, the older group had lower VAS and higher JOA scores after PETD than after CN (P<0.05), and there was no significant difference between the young group and middle-aged group (P>0.05). There was no significant difference in VAS and JOA scores at the same time between age groups by PETD treatment (P>0.05). The VAS was higher and the JOA score was lower in older group than in young group and middle-aged group at 1, 6 months after CN treatment(P<0.05). ②△T and ROM outcomes, in the same age group and same treatment method, postoperative △T and ROM at different time points were obviously improved(P<0.05). There was no significant difference in △T between two methods of PETD and CN at the same age(P>0.05), there was no significant difference in ROM between young group and middle-aged group(P>0.05), ROM was higher after PETD treatment than after CN treatment(P<0.05). There was no significant difference in △T and ROM at the same time between age groups by PETD treatment(P>0.05). There was no significant difference in △T between age groups by CN treatment, but the ROM was smaller in older group than in young group and middle-aged group after CN treatment(P<0.05). CONCLUSION Both PETD and CN for inclusive LDH have good efficacy, the curative benefit for older patients receiving PETD within 6 months after surgery more than CN, and CN is more appropriate for young and middle-aged patients.
Middle Aged ; Humans ; Aged ; Intervertebral Disc Displacement/surgery* ; Retrospective Studies ; Lumbar Vertebrae/surgery* ; Diskectomy, Percutaneous/methods* ; Treatment Outcome ; Endoscopy/methods* ; Diskectomy/methods*

OBJECTIVE: To evaluate the clinical efficacy of spinal endoscopy in the treatment of severe free lumbar disc herniation and explore the feasibility and application of microscopic drills to expand ventral space. METHODS: Thirty patients with severe free lumbar intervertebral disc herniation treated by spinal endoscopic technique from April 2019 to March 2021 were collected, including 19 males and 11 females;aged from 19 to 76 years with an average of (44.03±16.92) years old. All patients had a single segmental lesion with prolapse of the nucleus pulposus. Among them, there were 3 cases on L_2,3, 3 cases on L_3,4, 15 cases on L_4,5, and 9 cases on L₅S₁. During operation, posterior bone of vertebral body and pedicle notch were removed by a drill under the endoscope to enlarge the ventral space. And the free nucleus pulposus was exposed and completely removed. The intraoperative blood loss, operation time, hospital stay and postoperative neurological complications were recorded, and Japanese Orthopaedic Association (JOA) score, Oswestry Disability Index (ODI) and visual analogue scale (VAS) were compared before operation, 2 days, 3 months and 1 year after operation, and Macnab standard was used to evaluate clinical efficacy. RESULTS: All operations were successful and the free nucleus pulposus was completely removed. Pain in the lower back and legs was significantly relieved on the day after operation. Two patients experienced transient pain and numbness in lower limbs after operation, and no serious nerve injury complications occurred. ODI and VAS at each time point after surgery were significantly lower than those before surgery (P<0.01), and JOA score was significantly higher than before surgery (P<0.01). The excellent and good rates of Macnab were 66.67% (20/30), 83.33% (25/30) and 90.00% (27/30) on 2 days, 3 months and 1 year after operation, respectively. CONCLUSION For severe free lumbar intervertebral disc herniation, using of a drill under endoscope to expand the ventral space can smoothly remove the free nucleus pulposus and avoid nerve damage.
Male ; Female ; Humans ; Young Adult ; Adult ; Middle Aged ; Aged ; Intervertebral Disc Displacement/surgery* ; Feasibility Studies ; Diskectomy, Percutaneous/methods* ; Lumbar Vertebrae/surgery* ; Retrospective Studies ; Endoscopy/methods* ; Treatment Outcome ; Pain/surgery*

OBJECTIVETo assess the early curative effect of epidural or intravenous administration of steroids during a percutaneous endoscopic lumbar discectomy (PELD).

METHODS28 consecutive patients who underwent PELD due to large lumbar disc herniation between November 2014 and January 2016 were followed up for 6 months. These patients were divided into two groups according to the treatment they received after PELD. 14 patients (Group A) were treated by PELD and epidural steroids, while the other 14 patients (Group B) were treated by PELD and intravenous steroids. We evaluated the effectiveness by the preoperative and postoperative visual analogue scale (VAS) scores for back and leg pain, and the postoperative Oswestry disability index (ODI) at 3 weeks after surgery via the clinical charts and telephone interview. Postoperative hospital stay and time return to work were investigated as well.

RESULTSThere is a significant decrease in VAS (back, leg), ODI, and time return to work (p < 0.05). For VAS (back), Group A showed a significant decrease compared with Group B at 1 day and 1 week after surgery (p = 0.011, p = 0.017). As for VAS (leg), Group A showed a significant decrease compared with Group B at 1 day, 1 week, 3 weeks, and 3 months follow-up examinations (p = 0.002, p = 0.006, p < 0.001, p < 0.001). For ODI, Group A showed a notable decrease compared with Group B (p < 0.001). The postoperative hospital stay in two groups was not statistically different (p = 0.636). But the time return to work in Group A was significantly shorter than that in Group B (p = 0.023).

CONCLUSIONPatients who underwent PELD with epidural steroid administration for large lumbar disc herniation showed favorable curative effect compared with those who underwent PELD with intravenous steroid administration.

Adult ; Betamethasone ; administration & dosage ; Diskectomy, Percutaneous ; methods ; Endoscopy ; Female ; Glucocorticoids ; administration & dosage ; Humans ; Injections, Epidural ; Injections, Intravenous ; Intervertebral Disc Displacement ; surgery ; Length of Stay ; Lumbar Vertebrae ; surgery ; Male ; Pain Measurement ; Retrospective Studies

BACKGROUNDThis study evaluated the efficacy of percutaneous nucleoplasty using coblation technique for the treatment of chronic nonspecific low back pain (LBP), after 5 years of follow-up.

METHODSFrom September 2004 to November 2006, 172 patients underwent percutaneous nucleoplasty for chronic LBP in our department. Forty-one of these patients were followed up for a mean period of 67 months. Nucleoplasty was performed at L3/4 in 1 patient; L4/5 in 25 patients; L5/S1 in 2 patients; L3/4 and L4/5 in 2 patients; L4/5 and L5/S1 in 7 patients; and L3/4, L4/5, and L5/S1 in 4 patients. Patients were assessed preoperatively and at 1 week, 1 year, 3 years, and 5 years postoperatively. Pain was graded using a 10-cm Visual Analogue Scale (VAS) and the percentage reduction in pain score was calculated at each postoperative time point. The Oswestry Disability Index (ODI) was used to assess disability-related to lumbar spine degeneration, and patient satisfaction was assessed using the modified MacNab criteria.

RESULTSThere were significant differences among the preoperative, 1-week postoperative, and 3-year postoperative VAS and ODI scores, but not between the 3- and 5-year postoperative scores. There were no significant differences in age, sex, or preoperative symptoms between patients with effective and ineffective treatment, but there were significant differences in the number of levels treated, Pfirrmann grade of intervertebral disc degeneration, and provocative discography findings between these two groups. Excellent or good patient satisfaction was achieved in 87.9% of patients after 1 week, 72.4% after 1 year, 67.7% after 3 years, and 63.4% at the last follow-up.

CONCLUSIONSAlthough previously published short- and medium-term outcomes after percutaneous nucleoplasty appeared to be satisfactory, our long-term follow-up results show a significant decline in patient satisfaction over time. Percutaneous nucleoplasty is a safe and simple technique, with therapeutic effectiveness for the treatment of chronic LBP in selected patients. The technique is minimally invasive and can be used as part of a stepwise treatment plan for chronic LBP.

Adolescent ; Adult ; Diskectomy, Percutaneous ; methods ; Female ; Humans ; Low Back Pain ; surgery ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome ; Young Adult

Diskectomy, Percutaneous ; adverse effects ; methods ; Endoscopy ; methods ; Humans ; Intervertebral Disc Displacement ; surgery ; Lumbar Vertebrae ; surgery ; Minimally Invasive Surgical Procedures ; adverse effects ; methods